3D-computed tomography to compare the dimensions of the left atrial appendage in patients with normal sinus rhythm and those with paroxysmal atrial fibrillation
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Although paroxysmal atrial fibrillation (PAF) is an important cause of cardioembolic stroke, in contrast to chronic AF patients, the anatomical features of the left atrial appendage (LAA) in PAF patients remain unknown. Here, we investigated differences in LAA structures in patients with PAF and those with normal sinus rhythms (NSR) using 3D-computed tomography (3D-CT), which allows us to visualize complicated LAA structures at high spatial resolution. Study subjects were 30 consecutive PAF and 30 NSR patients with complete enhanced cardiac 3D-CT images available. After reconstruction of 3D LAA images, anatomical parameters of the LAA were measured and compared according to three proposed definitions of the LAA orifice plane determined by the following anatomical landmarks: DEF#1, center of warfarin ridge and centerline of proximal left circumflex artery; DEF#2, slope of warfarin ridge and mitral valve annulus; DEF#3, observers’ discretion by progressive rotation using the observers’ best estimate without the use of landmarks. The LAA volumes of the PAF groups were significantly greater than the NSR group according to all 3 definitions (DEF#1: 1.43 times, DEF#2: 1.44 times, and DEF#3: 1.36 times greater). The LAA orifice area was significantly larger in PAF than in NSR according to DEF#2, but was similar by DEF#1 and DEF#3. Intra-observer and inter-observer variations for any LAA measurements were very low. In conclusion, 3D-CT-based quantitative assessment of the LAA provides highly reproducible and detailed measurements, which can successfully discriminate differences of LAA volume between patients with NSR and those with PAF, suggesting significantly greater volumes in the latter.
KeywordsLeft atrial appendage Cardioembolic stroke Paroxysmal atrial fibrillation Orifice Computed tomography
The authors would like to thank Tadashi Sasaki, Kota Takeda, Takuya Chiba, Yuta Ueyama, Akinobu Sasaki, Kei Kikuchi, Takanori Ueda (radiation technologists of Iwate Medical University), Toru Kato, Hiroki Takahashi (graduate students of Iwate Prefectural University) for collecting data and coaching of image-editing in this study.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This study is a retrospective study. For this type of study formal consent is not required.
- 1.Disertori M, Franzosi MG, Barlera S, Cosmi F, Quintarelli S, Favero C, Cappellini G, Fabbri G, Maggioni AP, Staszewsky L, Moroni LA, Latini R, Investigators G-A (2013) Thromboembolic event rate in paroxysmal and persistent atrial fibrillation: data from the GISSI-AF trial. BMC Cardiovasc Disord 13:28CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Nucifora G, Faletra FF, Regoli F, Pasotti E, Pedrazzini G, Moccetti T, Auricchio A (2011) Evaluation of the left atrial appendage with real-time 3-dimensional transesophageal echocardiography: implications for catheter-based left atrial appendage closure. Circ Cardiovasc Imaging 4:514–523CrossRefPubMedGoogle Scholar
- 6.Matsumoto Y, Morino Y, Kumagai A, Hozawa M, Nakamura M, Terayama Y, Tashiro A (2017) Characteristics of anatomy and function of the left atrial appendage and their relationships in patients with cardioembolic stroke: a 3-dimensional transesophageal echocardiography study. J Stroke Cerebrovasc Dis 26:470–479CrossRefPubMedGoogle Scholar
- 8.Budge LP, Shaffer KM, Moorman JR, Lake DE, Ferguson JD, Mangrum JM (2008) Analysis of in vivo left atrial appendage morphology in patients with atrial fibrillation: a direct comparison of transesophageal echocardiography, planar cardiac CT, and segmented three-dimensional cardiac CT. J Interv Card Electrophysiol 23:87–93CrossRefPubMedGoogle Scholar
- 10.Mobius-Winkler S, Sandri M, Mangner N, Lurz P, Dahnert I, Schuler G (2012) The WATCHMAN left atrial appendage closure device for atrial fibrillation. J Vis Exp 60:3671Google Scholar
- 17.Di Biase L, Santangeli P, Anselmino M, Mohanty P, Salvetti I, Gili S, Horton R, Sanchez JE, Bai R, Mohanty S, Pump A, Cereceda Brantes M, Gallinghouse GJ, Burkhardt JD, Cesarani F, Scaglione M, Natale A, Gaita F (2012) Does the left atrial appendage morphology correlate with the risk of stroke in patients with atrial fibrillation? Results from a multicenter study. J Am Coll Cardiol 60:531–538CrossRefPubMedGoogle Scholar
- 23.Holmes DR, Reddy VY, Turi ZG, Doshi SK, Sievert H, Buchbinder M, Mullin CM, Sick P, Investigators PA (2009) Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial. Lancet 374:534–542CrossRefPubMedGoogle Scholar
- 24.Reddy VY, Doshi SK, Sievert H, Buchbinder M, Neuzil P, Huber K, Halperin JL, Holmes D, Investigators PA (2013) Percutaneous left atrial appendage closure for stroke prophylaxis in patients with atrial fibrillation: 2.3-Year Follow-up of the PROTECT AF (Watchman Left Atrial Appendage System for Embolic Protection in Patients with Atrial Fibrillation) Trial. Circulation 127:720–729CrossRefPubMedGoogle Scholar
- 28.Veinot JP, Harrity PJ, Gentile F, Khandheria BK, Bailey KR, Eickholt JT, Seward JB, Tajik AJ, Edwards WD (1997) Anatomy of the normal left atrial appendage: a quantitative study of age-related changes in 500 autopsy hearts: implications for echocardiographic examination. Circulation 96:3112–3115CrossRefPubMedGoogle Scholar
- 31.Fukushima K, Fukushima N, Kato K, Ejima K, Sato H, Fukushima K, Saito C, Hayashi K, Arai K, Manaka T, Ashihara K, Shoda M, Hagiwara N (2016) Correlation between left atrial appendage morphology and flow velocity in patients with paroxysmal atrial fibrillation. Eur Heart J Cardiovasc Imaging 17:59–66PubMedGoogle Scholar