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Isoproterenol loading transesophageal echocardiography in atrial fibrillation

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Abstract

In patients with sludge or severe spontaneous echo contrast (SEC) in the left atrial appendage (LAA), cases with isoproterenol loading transesophageal echocardiography (ISP-TEE) have been reported to identify the presence of thrombus in the LAA. This study aimed to assess the validity and hemodynamic changes of ISP-TEE in the LAA. We prospectively enrolled patients with atrial fibrillation (AF) who underwent ISP-TEE. The degree of sludge/SEC was categorized as being either absent (grade 0), mild SEC (grade 1), moderate SEC (grade 2), severe SEC or sludge (grade 3). The hemodynamic evaluation was performed by measuring LAA flow velocity, LAA tissue Doppler imaging (LAA-TDI) velocity, and pulmonary vein systolic forward flow velocity (PVS). In total, 35 patients (mean age 71 ± 7 years; 71% male) underwent ISP-TEE. Among 35 patients, 30 patients had grade 3 or 2 SEC, 5 patients had grade 1 SEC. After ISP loading, 23 patients (66% of all patients) showed improved sludge/SEC and one patient was diagnosed with thrombus in the LAA. There were 25 patients with grade 1 SEC, or no SEC (classified as Group1), 10 patients had residual sludge or grade 2 to 3 SEC (classified as Group2) after ISP administration. LAA flow, LAA-TDI, and PVS velocities were significantly higher in group 1 than in group 2 after ISP administration. There was no complication during the examination and after 24 h and 3 months. ISP infusion may be a potential tool to recognize LAA thrombus under the sludge/SEC during TEE in AF.

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Data are available upon reasonable request.

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Funding

This work was supported by Takeda Science Foundation (to K. Kusunose). The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, Japan

    Tomonori Takahashi, Kenya Kusunose, Shuji Hayashi, Robert Zheng, Yoshihito Saijo, Takayuki Ise, Koji Yamaguchi, Shusuke Yagi, Takeshi Soeki, Tetsuzo Wakatsuki & Masataka Sata

  2. Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan

    Natsumi Yamaguchi, Sae Morita, Yukina Hirata & Susumu Nishio

  3. Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan

    Hirotsugu Yamada

Authors
  1. Tomonori Takahashi
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  2. Kenya Kusunose
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  3. Shuji Hayashi
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  4. Robert Zheng
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  5. Natsumi Yamaguchi
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  7. Yukina Hirata
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  8. Susumu Nishio
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  9. Yoshihito Saijo
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  10. Takayuki Ise
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  12. Shusuke Yagi
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  13. Hirotsugu Yamada
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  14. Takeshi Soeki
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  15. Tetsuzo Wakatsuki
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  16. Masataka Sata
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Contributions

Design of the work: TT, KK, and SH. Conduct of the work and data acquisition: TT, SH, NY, SM, YH, SN, YS, TI, KY, SY, HY, TS, and TW. Data analysis and interpretation: TT and KK. Drafting the work: TT, KK, SH, and RZ. Reviewing the work and providing input: all authors. Final approval: all authors.

Corresponding author

Correspondence to Kenya Kusunose.

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Takahashi, T., Kusunose, K., Hayashi, S. et al. Isoproterenol loading transesophageal echocardiography in atrial fibrillation. Int J Cardiovasc Imaging 39, 511–518 (2023). https://doi.org/10.1007/s10554-022-02749-y

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