Key result
Increased indexed left atrial appendage volume (OR 1.18), early filling defects, decreased flow velocity, and persistent atrial fibrillation were significant independent predictors of spontaneous echocardiographic contrast.
Why the study?
Cardiac CT depiction of the relationship between spontaneous echocardiographic contrast and findings of the left atrial appendage had not been reported.
Observational (n=641)
Blinded to patient history and TEE results
No
Cardiac CT findings, specifically increased left atrial appendage volume and early filling defects, can serve as noninvasive predictors of spontaneous echocardiographic contrast in patients with atrial fibrillation.
Purpose Cardiac computed tomography (CT) depiction of the relationship between spontaneous echocardiographic contrast (SEC) and findings of the left atrial appendage (LAA) has not been reported. We evaluated predictors of SEC within the LAA using findings of cardiac CT in patients with atrial fibrillation (AF). Methods We retrospectively analyzed cardiac CT findings of the LAA, including morphology, volume, and filling defects, of 641 patients who underwent Transesophageal echocardiography (TEE) prior to pulmonary vein isolation (PVI) from January 6, 2013 through December 16, 2019 at our institution. We investigated potential associated factors that might be predictors of SEC and computed a receiver operator characteristic,choosing a threshold value at which the likelihood of SEC could be predicted based on the LAA volume indexed for body size. Results SEC correlated significantly with history of persistent AF ( P <0.001; odds ratio [OR], 3.74; 95% confidence interval [CI], 1.91–7.29), LAA early filling defects ( P =0.003; OR, 2.83; 95% CI, 1.43–5.62), LAAFV ( P <0.001; OR, 0.97; 95% CI, 0.96–0.99), and indexed LAA volume ( P = 0.001; OR, 1.18; 95% CI, 1.07–1.30) of 8.04 cm 3 /m 2 or greater (sensitivity, 75.0%; specificity, 48.7%).The addition of LAAFV to indexed LAA volume increased the area under the receiver operator characteristic curve from 0.642 to 0.724 ( P < 0.001). Conclusion Findings of LAA in cardiac CT might allow the noninvasive estimation of SEC and additional information for risk stratification and management of thromboembolic events in patients with AF.
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Ouchi et al. (2021) conducted an observational in Atrial Fibrillation (n=641). Indexed left atrial appendage (LAA) volume vs. Lower indexed LAA volume was evaluated on Presence of spontaneous echocardiographic contrast (SEC) in the left atrial appendage (OR 1.18, 95% CI 1.07-1.30, p=0.001). Increased indexed left atrial appendage volume (OR 1.18), early filling defects, decreased flow velocity, and persistent atrial fibrillation were significant independent predictors of spontaneous echocardiographic contrast.