A 3D end-systolic left atrial appendage volume of ≥9.3 mL was significantly associated with increased mortality at 2 years compared to <9.3 mL (11 vs 3 deaths, P=0.02) in patients with atrial fibrillation.
Observational (n=206)
Yes
Does 3D transesophageal echocardiography evaluation of left atrial appendage volume correlate with prothrombotic state and 2-year prognosis in patients with atrial fibrillation?
3D transesophageal echocardiography measurement of left atrial appendage volume provides a quantifiable marker of atrial remodeling that correlates with prothrombotic risk and mid-term mortality in patients with atrial fibrillation.
Absolute Event Rate: 11% vs 3%
p-value: p=0.02
BACKGROUND Left atrial (LA) volume is an echocardiographic marker of remodeling, thromboembolic risk, and prognosis in atrial fibrillation (AF); limited data are available on LA appendage (LAA) characterization beyond morphology. We sought to evaluate LAA characteristics in 2-dimensional (2D) and 3-dimensional (3D) transesophageal echocardiography (TEE) and the correlation with LA/LAA prothrombotic state and prognosis. METHODS We prospectively studied 206 hospitalized patients with AF using 2D transthoracic echocardiography (TTE) and 2D/3D TEE of the LAA ≤24 hours from admission. Patients were divided according to the presence or absence of LAA sludge and/or thrombus. Data on clinical events were collected for 2 years. RESULTS Patients with LAA sludge/thrombus (n=35) on admission had higher LA volumes, lower left ventricular ejection fraction, lower LAA emptying and filling flow velocity, larger 2D LAA measurements (2D LAA ostium diameter, 2D LAA area) as well as larger 3D LAA measurements (higher 3D LAA volumes (LAAV), higher 3D end-systolic ES LAA ostium area), and more frequently non-chicken wing morphology. On multivariable logistic regression analysis, LAA filling flow velocity and 3D ES LAAV were associated with the presence of LAA sludge/thrombus at admission ( P =0.031 and P <0.0001 respectively). Receiver operating characteristic curve analysis revealed the optimal cut-off for 3D ES LAAV to discriminate patients at risk of death within 2 years was 9.3 mL. Kaplan–Meier curves demonstrated a significant difference in survival at 2-year follow-up according to this value: 3 deaths occurred in the group with 3D ES LAAV <9.3mL and 11 in those with volume ≥9.3 mL ( P =0.02). CONCLUSIONS 3D characterization of LAAV depicts a degree of LAA remodeling in AF that appears associated with LA/LAA thrombogenicity and mid-term prognosis. CONDENSED ABSTRACT Limited data are available on left atrial appendage (LAA) remodeling in atrial fibrillation (AF). We hypothesized that 3-dimensional (3D) evaluation of the LAA volume in AF could help to refine the prothrombotic state and prognosis in AF. Patients with LAA sludge and/or thrombus exhibited lower LAA filling and emptying flow velocities, and higher 2-dimensional (2D) and 3D LAA measurements. On multivariable analysis, LAA filling flow velocity and 3D end-systolic LAA volume were associated with the presence of LAA sludge/thrombus at admission (respectively, P =0.031 and P <0.0001). Kaplan–Meier curves demonstrated a significant difference in survival at 2 years according to 3D ES LAA volume ( P =0.02). Three dimensional LAA volume reflects the degree of LAA remodeling in AF and is associated with prothrombotic state and prognosis.
Soulat-Dufour et al. (Thu,) conducted a observational in Atrial Fibrillation (n=206). 3D end-systolic left atrial appendage volume (LAAV) ≥9.3 mL vs. 3D end-systolic LAAV <9.3 mL was evaluated on Death at 2-year follow-up (p=0.02). A 3D end-systolic left atrial appendage volume of ≥9.3 mL was significantly associated with increased mortality at 2 years compared to <9.3 mL (11 vs 3 deaths, P=0.02) in patients with atrial fibrillation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: