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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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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.

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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.

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan

    Maiko Hozawa, Yoshihiro Morino, Yuki Matsumoto & Kyohei Nagata

  2. Department of Radiology, Iwate Medical University, Morioka, Iwate, Japan

    Ryoichi Tanaka & Kunihiro Yoshioka

  3. Division of Cardioangiology, Nephrology and Endocrinology, Department of Internal Medicine, Iwate Medical University, Morioka, Iwate, Japan

    Akiko Kumagai

  4. Division of Cardioangiology, Nephrology and Endocrinology, Department of Laboratory Medicine, Iwate Medical University, Morioka, Iwate, Japan

    Atsushi Tashiro

  5. Faculty of Software and Information Science, Iwate Prefectural University, Morioka, Iwate, Japan

    Akio Doi

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  1. Maiko Hozawa
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  2. Yoshihiro Morino
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  3. Yuki Matsumoto
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  4. Ryoichi Tanaka
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  5. Kyohei Nagata
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  6. Akiko Kumagai
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  7. Atsushi Tashiro
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  8. Akio Doi
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  9. Kunihiro Yoshioka
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Correspondence to Yoshihiro Morino.

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

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Hozawa, M., Morino, Y., Matsumoto, Y. et al. 3D-computed tomography to compare the dimensions of the left atrial appendage in patients with normal sinus rhythm and those with paroxysmal atrial fibrillation. Heart Vessels 33, 777–785 (2018). https://doi.org/10.1007/s00380-018-1119-3

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  • DOI: https://doi.org/10.1007/s00380-018-1119-3

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