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Prediction of spontaneous echocardiographic contrast within the left atrial appendage in cardiac computed tomography of patients with atrial fibrillation

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Abstract

This study aimed to assess the predictors of spontaneous echocardiographic contrast (SEC) using left atrial appendage (LAA) findings in cardiac computed tomography (CT) of patients with atrial fibrillation (AF). 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 using cardiac CT findings 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. SEC correlated significantly with indexed LAA volume (P < 0.001; odds ratio [OR], 1.31; 95% confidence interval [CI], 1.17–1.48) of 7.75 cm3/m2 or greater (sensitivity, 76.0%; specificity, 57.7%), LAA early filling defect (P = 0.005; OR, 2.72; 95% CI, 1.35–5.48), a history of persistent AF (P < 0.001; OR, 3.81; 95% CI, 1.86–7.80), and LAA flow velocity (P < 0.001; OR, 0.97; 95% CI, 0.96–0.99). Findings of LAA in cardiac CT can allow for the noninvasive estimation of SEC to determine the need for additional TEE investigation and the need to obtain additional information for risk stratification and management of thromboembolic events in patients with AF.

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Availability of data and materials

The datasets generated during and/or analyzed during the current study are not publicly available, but fully anonymized raw data and images will be available from the corresponding author on reasonable request.

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This research received no grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan

    Kotaro Ouchi, Toru Sakuma, Takahiro Higuchi & Hiroya Ojiri

  2. Department of Cardiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan

    Jun Yoshida, Ryosuke Narui & Teiichi Yamane

  3. Department of Laboratory Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan

    Ayumi Nojiri

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  1. Kotaro Ouchi
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Contributions

KO: conceptualization, methodology, validation, formal analysis, data curation, writing—original draft, writing—review and editing, visualization, project administration. TS: methodology, validation, writing—review and editing. TH: validation, formal analysis, data curation. JY: investigation, resources. RN: investigation, resources. AN: investigation, resources. TY: investigation, resources. HO: supervision.

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Correspondence to Kotaro Ouchi.

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Conflict of interest

Teiichi Yamane received Speaker honoraria from DAIICHI SANKYO COMPANY, Ltd., Japan, Boerringer Ingelheim, Abbott Japan, Bristol-Myers Squibb, Medtronic Japan, and Japan LifeLine, and research grants from Boehringer Ingelheim. There is no conflict of interest to disclose directly related to this manuscript. The other authors have no conflict of interest.

Ethics approval and consent to participate

This study was conducted in accordance with the Declaration of Helsinki. Approval was obtained from the ethics committee of the Jikei University School of Medicine (Approval Number: 32-210(10291)).

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The institutional review boards of the participating institutions approved this retrospective study and waived the need for documentation of informed consent. Informed consent was obtained in the form of opt-out on the website.

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Ouchi, K., Sakuma, T., Higuchi, T. et al. Prediction of spontaneous echocardiographic contrast within the left atrial appendage in cardiac computed tomography of patients with atrial fibrillation. Heart Vessels 38, 1138–1148 (2023). https://doi.org/10.1007/s00380-023-02263-8

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