Dobutamine-assisted exclusion of left atrial appendage thrombus in atrial fibrillation patients with sludge

Figures

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  Fig. 1. Flow chart illustrating the study population. Among 1142 patients undergoing TOE during the study period, 20 patients with dense SEC or sludge meeting the inclusion criteria were enrolled. Detailed inclusion and exclusion criteria are provided in the Supplemental methods. AF, atrial fibrillation; BP, blood pressure; HR, heart rate; LAA, left atrial appendage; SEC, spontaneous echo contrast; TOE, transoesophageal echocardiography.

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  Fig. 2. Effects of dobutamine on the functions of LAA and LV. Changes in LAA flow velocity (A), LAA emptying fraction (B), LAA medial wall velocity (C), LAA lateral wall velocity (D), and LVEF (E) at baseline and after dobutamine infusion are shown. In the box plots, the median is represented by a horizontal line within the box and the mean by a cross mark. The number near the box indicates the median value. P-values were calculated using the Wilcoxon signed-rank test. DOB, dobutamine; LAA, left atrial appendage; LVEF, left ventricular ejection fraction.

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  Fig. 3. Hemodynamic effects of dobutamine. Bar charts (primary axis) illustrate changes in systolic and diastolic blood pressure before, during, and up to 10 min after dobutamine infusion. The line graph (secondary axis) shows changes in heart rate. Bars and markers represent the estimated marginal means of measurements at each time point, and error bars indicate 95% confidence intervals. P-values were calculated using a linear mixed-effects model. DOB, dobutamine.

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  Fig. 4. Changes in the severity of LAA blood stasis from baseline to dobutamine infusion. The severity of LAA blood stasis, incorporating SEC grades and sludge, as assessed by the first observer at baseline and at the peak dobutamine dose, is shown. Boxes represent the proportions of each level of blood stasis severity. P-values were calculated using the Wilcoxon signed-rank test. DOB, dobutamine; SEC, spontaneous echo contrast.

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  Fig. 5. Representative case of sludge resolution with dobutamine infusion. A 64-year-old male patient with dilated cardiomyopathy and a mildly reduced LVEF of 46% presented with LAA sludge at baseline. Dobutamine infusion (20 μg/kg/min) improved LVEF and LAA function, reducing SEC to grade 1. DOB, dobutamine; LAA, left atrial appendage; LVEF, left ventricular ejection fraction; SEC, spontaneous echo contrast.