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Heart and Vessels

, Volume 33, Issue 7, pp 777–785 | Cite as

3D-computed tomography to compare the dimensions of the left atrial appendage in patients with normal sinus rhythm and those with paroxysmal atrial fibrillation

  • Maiko Hozawa
  • Yoshihiro MorinoEmail author
  • Yuki Matsumoto
  • Ryoichi Tanaka
  • Kyohei Nagata
  • Akiko Kumagai
  • Atsushi Tashiro
  • Akio Doi
  • Kunihiro Yoshioka
Original Article

Abstract

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.

Keywords

Left atrial appendage Cardioembolic stroke Paroxysmal atrial fibrillation Orifice Computed tomography 

Notes

Acknowledgements

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.

Ethical standards

This study is a retrospective study. For this type of study formal consent is not required.

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Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Cardiology, Department of Internal MedicineIwate Medical UniversityMoriokaJapan
  2. 2.Department of RadiologyIwate Medical UniversityMoriokaJapan
  3. 3.Division of Cardioangiology, Nephrology and Endocrinology, Department of Internal MedicineIwate Medical UniversityMoriokaJapan
  4. 4.Division of Cardioangiology, Nephrology and Endocrinology, Department of Laboratory MedicineIwate Medical UniversityMoriokaJapan
  5. 5.Faculty of Software and Information ScienceIwate Prefectural UniversityMoriokaJapan

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