房颤患者左心耳血栓形成与结构功能的关系

目的 分析房颤患者血栓形成与左心耳结构功能的关系。方法 采用经食管超声心动图检测88例房颤患者及18例对照组患者的左心腔前后径(LA-D)、左心耳入口宽度(LAA-W)、左心耳长度(LAA-L)、左心耳前壁、后壁及顶部的运动速度及左心耳充盈及排空速度等指标。根据左心耳内透声,将房颤患者分为无自发显影(NO SEC)亚组、自发显影(SEC)亚组、泥浆样改变(sludge)亚组和血栓(thrombosis)亚组,并将各指标与对照组进行比较。结果 与对照组相比,房颤组患者左心耳结构及功能均有不同程度的改变;sludeg亚组及thrombosis亚组的LAA-W均较对照组增大,差异有统计学意义(P均<0.05);血栓亚组的LAA-L较对照组增大,差异有统计学意义(P<0.01);房颤各亚组的LA-D均较对照组扩大(P均<0.05);房颤各亚组的左心耳充盈及排空速度均较对照组降低(P均<0.05),在血栓亚组降低更为明显;除无自发显影亚组外,余各亚组的左心耳各壁运动速度差异均有统计学意义(P均<0.01)。结论 房颤患者左心耳内血栓形成与左心耳的结构以及功能改变密切相关。     

经食管超声心动图组织多普勒评价左心耳功能

目的观察窦性心律和心房纤颤（房颤）患者经食管超声心动图左心耳脉冲组织多普勒的图像特点,结合脉冲多普勒初步研究使用组织多普勒技术评价左心耳功能的价值。 方法窦性心律和房颤患者各15例均经食管超声心动图检查,房颤患者根据有无心房血栓或心房血流浓密自显影分为2组,并将经食管超声心动图的指标进行比较。 结果窦性心律患者的左心耳血流频谱和脉冲组织多普勒图像为可测量的三相波;房颤患者则表现为无规律的可测量的多相波。左心耳血流速度在各组间均有显著性差异;脉冲组织多普勒指标在窦性心律和房颤患者中有显著性差异,在有血栓和心房血流自显影的房颤患者中进一步降低或有进一步降低的趋势。 结论经食管超声心动图检查能获得可测量的左心耳（包括房颤患者）组织多普勒图像,可作为分析左心耳功能的重要补充。     

Evaluation of mitral regurgitation by pulmonary venous blood flow patterns. Relation to angiographic and haemodynamic parameters in subgroups of patients

Summary. Objectives: to study the relationship between pulmonary venous systolic flow fraction (PVSFfr) recorded using pulsed Doppler transesophageal echocardiography and angiographic grading and haemodynamic parameters in subgroups of patients with mitral regurgitation. Background: reversed systolic pulmonary venous flow is a sensitive sign of severe mitral regurgitation. Scarse data are available regarding the effects of atrial fibrillation and coronary artery disease. Methods: PVSFfr was calculated as the systolic flow velocity integral divided by the total inflow integral. PVSFfr is negative when systolic flow is dominantly reversed. 111 patients were studied. Results: PVSFfr<0 was 91% sensitive for angiographic severe mitral regurgitation (MR) (specificity 75%). In patients with sinus rhytm and without coronary artery disease the sensivity was 100% and specificity was 86% (n= 25). PVSFfr correlated to angiographic grade (r= -0.63, P= 0.0001), mean PCW (r= -0.63, P= 0.0001), v-wave (r=-0.72, P= 0.0001), systolic blood pressure (r= 0.28, P= 0.003) and left atrial diameter (r= -0.42, P= 0.0001) (n= 111). Stepwise linear regression analysis revealed the v-wave, angiographic grading, left atrial diameter and systolic blood pressure to be independent predictors of PVSFfr. Subgroup analysis revealed a correlation (r= 0.85, n= 25) between angiographic grading and PVSFfr in patients with sinus rhythm without CAD and (r= 0.35, n= 23) in patients with CAD in atrial fibrillation. Conclusions: PVSFfr is valuable in assessing mitral regurgitation. In the presence of atrial fibrillation and coronary artery disease the correlation with angiographic grading decreases indicating the dynamic nature of this valvular lesion.     

Left atrial appendage function in patients with cardioembolic stroke in sinus rhythm and atrial fibrillation.

The purpose of this study was to determine the left atrial appendage (LAA) function in patients with stroke. The study group consisted of 61 patients with stroke and 37 control subjects. Patients with stroke were divided into 2 groups on the basis of the presence of atrial fibrillation (group 1) or sinus rhythm (group 2). Group 1 showed a significant reduction of LAA flow velocities (13.2 +/- 6.4 cm/s versus 27.5 +/- 8 cm/s, P <.05) and significant increase in LAA areas (minimum area: 360.5 +/- 204 mm(2) versus 217.7 +/- 113.9 mm(2), P =.004). Group 2 showed a decrease in LAA flow velocities (17.7 +/- 8.2 cm/s versus 27.5 +/- 8 cm/s, P <.05), but no significant change was found in LAA areas. No significant difference was found in other parameters related to LAA. These findings show that a decreased LAA flow velocity is a risk factor for stroke in patients in sinus rhythm without LAA enlargement. Left atrial appendage area was increased in size only in patients with atrial fibrillation.     

Contributing factors to formation of left atrial spontaneous echo contrast in mitral valvular disease

The formation of left atrial spontaneous echo contrast may relate to blood stasis. This study analyzed the factors contributing to the formation of that contrast. Transesophageal echocardiography, transthoracic echocardiography, cardiac catheterization, and left ventricular angiography were performed in 139 patients, divided into five groups. Predominant mitral stenosis with atrial fibrillation was found in 36 patients (group I); normal porcine valve in the mitral valvular area with atrial fibrillation in 31 (group II); predominant mitral stenosis with normal sinus rhythm in 26 (group III); moderate to severe mitral regurgitation with atrial fibrillation in 25 (group IV); atrial fibrillation with normal mitral valve in 21 (group V). The results showed left atrial spontaneous contrast echo was found in only 1 of 139 patients by transthoracic echocardiography and 62 of 139 cases were detected by transesophageal echocardiography. There was a high incidence of left atrial spontaneous echo contrast in cases of mitral obstruction with atrial fibrillation and enlarged left atrium (group I, 88%; group II, 74%), but a lower incidence in cases with normal sinus rhythm (group III, 4%), atrial fibrillation alone (group V, 16%), and increased left atrial flow velocity (group IV, 9.5%). The diameter of the left atrium was significantly different between presence and absence of left atrial spontaneous contrast echo (54.3 +/- 9.2 mm vs. 48.3 +/- 8.6 mm, p less than 0.01). The mean pressure gradient was similar in groups I and III (14.6 +/- 0.6 mHg and 14.4 +/- 2.8 mHg, respectively) but different in group II (10.9 +/- 3.2 mHg, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Dual-site right atrial pacing increases left atrial appendage flow in patients with sick sinus syndrome and paroxysmal atrial fibrillation

BACKGROUND: Dual-site right atrial pacing has been proposed as a promising concept for prevention of paroxysmal atrial fibrillation (PAF). Effects of this pacing configuration on left atrial appendage (LAA) flow and transmitral flow may be of prognostic and hemodynamic relevance. This study aims to characterize acute changes in left atrial flow depending on dual-site right atrial pacing. METHODS: In 12 patients (66 +/- 8.8 years, 4 women) with PAF and sinus bradycardia a pacemaker with a right atrial dual-site lead configuration (right atrial lateral and coronary sinus ostium) was implanted. Flow velocities in the left pulmonary vein (LPV), LAA, and across the mitral valve were assessed by transesophageal echocardiography and compared during sinus rhythm (SR) and dual-site (DS) pacing. RESULTS: Dual-site pacing resulted in higher maximum (SR: 0.57 m/s; pacing: 0.77 m/s; P < 0.02) and mean (SR: 0.33 m/s; DS: 0.47 m/s; P < 0.01) LAA emptying flow when compared with SR. The passive transmitral flow component (maximum E-wave velocity) was lower during dual-site pacing (SR: 0.53 m/s vs DS: 0.44 m/s, P < 0.02). The E/A ratio tended to be lower during dual-site pacing (SR: 1.21 vs DS: 1.01, P = 0,10). LPV flow velocities during SR and DS pacing did not differ. CONCLUSION: DS right atrial stimulation in patients with PAF increases the LAA emptying flow velocity and shifts the transmitral flow pattern towards a lower passive component when compared with sinus rhythm. The change in LAA flow may contribute to a lower incidence of thromboembolism and merits further investigation.     

Time interval determination from left atrial appendage ejection flow in patients with mitral stenosis

The feasibility of determining the time interval from left atrial appendage (LAA) flow was examined using transesophageal Doppler echocardiography. Time intervals were compared between LAA flow and mitral flow patterns during late diastole in 8 patients with mitral stenosis and in 12 controls. The start of ejection flow from the LAA was later than the initiation of mitral flow, but the termination was same in both flows, indicating the contribution of LAA ejection to the latter half of the left atrial booster pump function. The pre-ejection time and the time interval from P-wave to end-ejection correlated significantly with left atrial dimensions (r = 0.55, and r = 0.70, respectively). The pre-ejection time, duration of the ejection flow from the LAA, and duration of mitral flow in the atrial contraction phase were significantly longer in patients with mitral stenosis (126 ± 14 msec, 131 ± 36 msec, and 167 ± 28 msec, respectively) than in the controls (109 ± 13 msec, 108 ± 15 msec, and 141 ± 17 msec, respectively). These results indicate that electrical conduction time from the right atrium to LAA can be estimated from the LAA ejection flow, and the time is related to the left atrial size. In patients with mitral stenosis, LAA contraction may contribute to left ventricular filling in the latter half of the atrial contraction phase. © 1997 John Wiley & Sons, Inc. J Clin Ultrasound 25 : 97–102, 1997.     

Presence of accessory left atrial appendage/diverticula in a population with atrial fibrillation compared with those in sinus rhythm: a retrospective review

Accessory left atrial appendages and atrial diverticula have an incidence of 10–27%. Their association with atrial fibrillation needs to be confirmed. This study determined the prevalence, number, size, location and morphology of accessory left atrial appendages/atrial diverticula in patients with atrial fibrillation compared with those in sinus rhythm. A retrospective analysis of 47 consecutive patients with atrial fibrillation who underwent 320 multidetector Coronary CT angiography (CCTA) was performed. A random group of 47 CCTA patients with sinus rhythm formed the control group. The presence, number, size, location and morphology of accessory left atrial appendages and atrial diverticula in each group were analysed. Twenty one patients had a total of 25 accessory left atrial appendages and atrial diverticula in the atrial fibrillation group and 22 patients had a total of 24 accessory left atrial appendages and atrial diverticula in the sinus rhythm group. Twenty-one atrial diverticula were identified in 19 patients in the atrial fibrillation group and 19 atrial diverticula in 17 patients in the sinus rhythm group. The mean length and width of accessory left atrial appendage was 6.9 and 4.7 mm, respectively in the atrial fibrillation group and 12 and 4.6 mm, respectively, in the sinus rhythm group, P = ns (not significant). The mean length and width of atrial diverticulum was 4.7 and 3.6 mm, respectively in the atrial fibrillation group and 6.2 and 5 mm, respectively in the sinus rhythm group (P = ns). Eighty-four % and 96% of the accessory left atrial appendages/atrial diverticula in the atrial fibrillation and sinus rhythm groups were located along the right anterosuperior left atrial wall. Accessory left atrial appendages and atrial diverticula are common structures with similar prevalence in patients with atrial fibrillation and sinus rhythm.     

慢性心房颤动时上腔静脉血流动力学变化

目的　应用经胸超声心动图技术观察慢性心房颤动(房颤)时上腔静脉血流动力学的改变,探讨房颤对其血流频谱的影响及发生机制。方法　选择26例房颤患者和13 例窦性心律患者,采集上腔静脉多普勒血流频谱。测定上腔静脉收缩期S波、舒张早期D波和舒张晚期逆向 AR波的最大流速和流速积分;并与其他超声指标作相关性分析。结果　房颤时上腔静脉血流频谱各项指标与窦性心律组相比,收缩期 S波的峰值流速和流速积分显著降低(P<0.01);而舒张期 D波的峰值流速和流速积分无明显改变;舒张晚期逆向 AR波消失。上腔静脉收缩期S波峰值流速、流速积分与右房射血分数、右室射血分数、三尖瓣反流程度呈显著相关性(P<0.05~0.001)。舒张期D波峰值流速和流速积分与以上指标无显著相关性。结论　房颤时上腔静脉血流频谱形态明显改变,表现为舒张晚期逆向AR波消失;收缩期S波的峰值流速和流速积分较窦性心律时明显减小,舒张早期D波无明显变化,其血流频谱形态的改变很好地反映了右心压力的变化。     

瓣膜病合并巨大左心房与房颤的外科治疗

目的:评估在二尖瓣置换术同期行冲洗式射频消融术和左房折叠术(LAP)治疗巨大左心房慢性房颤(AF)的临床效果.方法:46例收缩末期左心房内径(LAD)≥60 mm或左心房客积指数≥55 mL/m2的二尖瓣病变合并慢性AF患者,实施二尖辫置换术与冲洗式单极射频消融术,其中同期加行左房折叠术(LAP组)23例,未加行LAP术的23例为对照组.应用超声心动图及心电图观察手术前后心功能、左室射血分数(LVEF)、左心房容积指数(LAVI)、心电活动的变化.随访1年.结果:LAP组和对照组恢复并维持窦性心律分别占82.6%和56.5%(P<0.01)、心功能改善级别分别为1.71±0.65和0.78±0.63(P<0.01)、手术后LAVl分别为39.88±11.02和51.86±13.09(P<0.01)、LAEF分别为(64.04±6.81)%和(55.69±5.32)%(P<0.01).结论:对合并巨大左心房的风湿性二尖瓣病变慢性AF患者,实施二尖瓣置换术和冲洗式射频消融术同期加行左房折叠术,更能有效消除AF,使窦性心律得以恢复和维持,使左心房、心室收缩功能得到进一步的改善,疗效非常明显.     

Use of an echocardiographic contrast agent to establish safety of cardioversion in a patient with a ligated left atrial appendage

Transesophageal echocardiographic-guided cardioversion is a safe, accepted technique to minimize risk of stroke and embolic events when electrically converting atrial fibrillation to normal sinus rhythm. The presence of thrombus in the left atrial appendage (LAA) is a contraindication to performing cardioversion in these patients. For patients with a surgically ligated LAA, thrombus may be more prevalent and may still represent an embolic risk because of incomplete closure of the LAA. We report use of an echocardiographic contrast agent in a patient with a thrombus in a ligated LAA to determine safety of cardioversion.     

Left atrial appendage-flow velocity predicts cardioversion success in atrial fibrillation

Restoration of sinus rhythm by electrical cardioversion is a therapeutic option in appropriately selected patients with atrial fibrillation. It is important to determine predictors of electrical cardioversion outcome in patients with atrial fibrillation. Predictive value of clinical and conventional echocardiographic parameters for predicting cardioversion outcome is limited. The role of left atrial appendage (LAA) function, which may reflect left atrial contractile function, for prediction of cardioversion outcome remains unclear. We conducted a single center prospective study to evaluate the role of LAA function for prediction of cardioversion success in patients with atrial fibrillation. One hundred sixty three patients with atrial fibrillation underwent transthoracic and transesophageal echocardiography (TEE) before electrical cardioversion. LAA functions, including LAA peak flow velocity, LAA area and LAA ejection fraction, were examined. Cardioversion was successful in 133 patients and unsuccessful in 30 patients. Mean LAA peak emptying flow velocity was significantly higher in the patients with successful cardioversion than in those with unsuccessful cardioversion (0.34 +/- 0.14 vs 0.27 +/- 0.1 m/sec; p = 0.013). At multivariate logistic regression analysis, only LAA flow velocity (> 0.28 m/sec, odds ratio = 2.8 ; p = 0.03) proved to be an independent predictor of cardioversion success. LAA area (p = 0.18) and LAA ejection fraction (p = 0.52) were not different between successful and unsuccessful cardioversion groups. Therefore, measurement of LAA flow velocity provides valuable information for prediction of cardioversion outcome in patients with atrial fibrillation before TEE guided cardioversion.     

经食管超声心动图对心房颤动时右心耳血流动力学的研究

目的　应用经食管超声心动图(TEE)技术观察慢性心房颤动(房颤)时右心耳结构、功能和血流流速曲线的改变。方法　选取 26例房颤患者和 13例窦性心律患者,采用TEE充分清楚显示右心耳图像并采集血流流速曲线和其他相应指标。结果　与对照组相比,房颤组右心房射血分数 (RAEF)和右心耳射血分数(RAAEF)均显著降低(P<0. 05~0. 01);房颤时右心耳血流流速曲线峰值排空、充盈流速和流速积分均显著下降(P<0. 05~0. 01)。右心耳峰值排空、充盈流速与右室射血分数 (RVEF)、RAAEF、RAEF、右心房最大面积(Smax RA)等指标具有显著的相关性。结论　TEE可以安全、准确地评价右心耳血流动力学情况;房颤时右心耳血流流速曲线是反映右心房、右心耳功能的良好指标。     

Increased serum oxidative stress in patients with severe mitral regurgitation: A new finding and potential mechanism for atrial enlargement

ObjectiveThe aim of this study was to examine the serum oxidative stress in patients with severe mitral regurgitation.Design and methodsThis study analyzed serum oxidative stress index in patients with severe mitral regurgitation [persistent atrial fibrillation (AF) or sinus rhythm], paroxysmal lone AF patients and healthy subjects.ResultsThe serum oxidative stress index was significantly higher in the mitral regurgitation AF group and sinus group than in the lone AF group and healthy subjects (p < 0.0001). Left atrial size was significantly larger in the mitral regurgitation AF group and sinus group than in the lone AF group and healthy subjects (p < 0.0001). The oxidative stress index significantly and positively correlated with left atrial size in the overall study population (r = 0.439, p = 0.0008).ConclusionsThis study provides new evidence of increased oxidative stress in human severe mitral regurgitation, probably contributing to atrial enlargement.     

Transesophageal echo-Doppler echocardiographic assessment of pulmonary venous flow patterns.

Fifty-eight of 61 consecutive patients undergoing transesophageal echo-Doppler echocardiography provided excellent signals to permit assessment of pulmonary venous blood low patterns. Normal antegrade pulmonary venous flow during ventricular systole was biphasic and was characterized by a short, low velocity (28 +/- 17 cm/sec), early systolic jet (P1), and longer, higher velocity (41 +/- 23 cm/sec), late systolic jet (P2). Antegrade pulmonary venous flow during ventricular diastole (P3) was of moderate velocity (34 +/- 17 cm/sec) and was monophasic; during atrial contraction there was transient, low velocity (-17 +/- 11 cm/sec) and reversal of flow (P4). The early systolic antegrade venous flow (P1) was absent or reversed in rhythm disorders, which interrupted normal synchronized atrioventricular activation. These rhythm disorders also were associated with diminished peak flow velocities during late systole (P2). Abnormalities in systolic left ventricular function and mitral regurgitation also had this effect. Diastolic flow velocities (P3) remained constant, except in patients with mitral regurgitation. In these patients diastolic peak flows were significantly increased above normal. In cases of atrial fibrillation or ventricular pacing the late diastolic reversal of flow resulting from atrial contraction (P4) was absent. Conclusions: Transesophageal echo-Doppler echocardiography gives high quality signals of pulmonary venous inflow to help assess function of the left ventricle and left atrium. Multiple factors affect the patterns. This study suggests caution in the interpretation of abnormal patterns, particularly of reduced systolic pulmonary vein flow in the presence of left ventricular dysfunction, atrial fibrillation, ventricular pacing, and mitral regurgitation.     

TEE结合2D-STI技术探讨房颤患者左心耳功能与射频消融术后房颤复发的关系

目的:应用经食道超声心动图(TEE)探讨房颤(AF)患者左心耳(LAA)功能变化与射频消融术后AF复发的关系。方法:选取2017年2月-2019年4月沈阳医学院附属第二医院心血管内科收治的AF患者68例,所有患者分别于射频消融术前24~48 h、术后24~48 h及3月行TEE检查,术后3月再根据患者复律的情况,分为窦性心律组(A组)及AF复发组(B组),测量患者LAA充盈及排空速率(LAA-Fv、LAA-Ev),LAA最大开口内径(LAA-D),LAA最大深度(LAA-L),LAA射血分数(LAA-EF)及LAA收缩期应变率(LAA-Ssr)等。比较术前、术后各指标的差异并分析其与AF复发的关系。结果:术后24~48 h与术前相比,患者LAA-Fv、LAA-Ev、LAA-EF、LAA-Ssr、LAA-L及LAA-D均未见明显变化(P>0.05);术后3月:A组(51例)与术前相比,LAA-Ev、LAA-Fv、LAA-EF,LAA-Ssr均明显增高,LAA-D明显缩小,差异有统计学意义(P<0.05);B组(17例)与术前相比,LAA-Ev、LAA-Fv、LAA-EF,LAA-Ssr明显降低,LAA-D明显增大,差异有统计学意义(P<0.05),B组另有4例患者LAA内出现血流自发显影(SEC)。二元Logistic回归分析显示LAA-Ev、LAA-Fv、LAA-EF及LAA-Ssr均是AF复发的预测因子,其对应的ROC曲线下面积分别为0.864、0.817、0.803及0.887。结论:LAA-Ev、LAA-Fv、LAA-EF及LAA-Ssr均可作为射频消融术后AF复发的预测因子,且LAA-Ssr的预测效能更优。     

经食管超声心动图对心房颤动患者右心耳自发显影回声和血栓发生的研究

目的探讨经食管超声心动图(TEE)观察慢性心房颤动(房颤)时右心房、右心耳自发显影(SEC)和血栓发生情况。方法选取26例房颤患者和13例窦性心律患者，常规经胸超声心动图资料留取后，采用TEE充分清楚显示左、右心耳图像并采集血流流速曲线和其他相应指标。结果26例房颤患者左心耳内均可测及SEC，共测及血栓形成者10例；房颤患者右心耳内有SEC者共17例，共测及右心耳血栓形成者1例。结论房颤时右心耳内可有血栓发生，TEE检查在房颤抗凝治疗中和复律前后具有重要意义。     

Assessment of left atrial appendage filling pattern by using intravenous administration of microbubbles: comparison between mitral stenosis and mitral regurgitation.

Mitral stenosis (MS) and mitral regurgitation (MR) are the most frequent conditions that cause a dilation and dysfunction of the left atrial appendage (LAA). Despite similarly dilated LAA in patients with MS and MR, the incidence of LAA thrombi and the risk of thromboembolism is different between these patients. The purpose of this study was to characterize the filling pattern of LAA by using intravenous administration of perfluorocarbon-exposed dextrose albumin (PESDA) during transesophageal echocardiographic examination in patients with MS and MR. Twenty-four patients with moderate to severe MS, 12 patients with severe MR, and a control group including 30 patients with conditions other than mitral valve disease underwent transesophageal echocardiographic examination with an intravenous bolus injection of PESDA. LAA emptying and filling velocities and maximal and minimal areas of LAA and LAA ejection fraction were measured. Digital gray-scale intensity (GSI) of the left atrial (LA) and LAA cavity after PESDA injection was measured by off-line analysis. Compared with control patients, patients with MS or MR had larger maximal and minimal areas of LAA and reduced LAA ejection fraction. LAA peak emptying flow velocity was significantly lower in patients with MS compared with those of MR or control patients. LAA peak filling velocity was significantly lower in patients with MS compared with that of control patients. However, there was no significant difference of LAA peak filling velocity between the patients with MS and MR. There was no significant difference of GSI ratio of LAA and LA between patients with MR and control patients; however, GSI ratio of LAA and LA was significantly lower in patients with MS compared with that of MR. The incidence of LAA spontaneous echo contrast and LAA thrombi in patients with MS was significantly higher than that of the patients with MR and control subjects (P <.005). Despite similarly dilated LAA area and depressed contractile function of LAA in patients with MS and MR compared with control patients, profoundly impaired LAA filling with resultant flow stasis was demonstrated by contrast echocardiography in patients with MS. These findings may explain the higher incidence of LAA spontaneous echo contrast and thrombus in patients with MS.     

Assessment of left atrial appendage wall velocities by transesophageal tissue Doppler echocardiography: a clinical study in patients with sinus rhythm.

To assess left atrial appendage (LAA) wall velocities, 42 patients in sinus rhythm underwent tissue Doppler interrogation during a clinically indicated transesophageal echocardiography. Color Doppler (B-mode and M-mode) and pulsed Doppler of LAA walls were obtained and analyzed in all patients. Color-coded tissue Doppler rendered a qualitative assessment of LAA wall, depicting both the timing and the sequence of LAA contraction. With pulsed Doppler interrogation, a triphasic signal was recorded in all patients, consisting of a positive wave (D1), followed by a biphasic wave (positive D2 and negative D3). Peak velocities of D1, D2, and D3 were 6.1 +/- 2, 20.1 +/- 7, and 16.1 +/- 5 cm/s, respectively. Mean coefficient of variation of LAA wall velocities was 6%, significantly lower than that of LAA percentage area change (29%). Compared with patients with abnormal relaxation, patients with normal mitral inflow had higher D1 peak velocities (7.3 +/- 1.2 vs 4.3 +/- 1 cm/s, respectively; P <.0001). Time sequence of ECG, LAA flow, and mitral inflow indicates that D1 component of LAA wall occurs in early diastole and is likely due to the upward movement of the mitral ring toward the base of the LAA wall. In conclusion, evaluation of LAA wall using tissue Doppler is feasible and reproducible. Although color tissue Doppler analysis allows a qualitative assessment, pulsed Doppler gives new quantitative insights for the comprehensive assessment of LAA wall dynamics, which complements the information obtained with flow interrogation.     

Measurement of left atrial appendage size by transesophageal echocardiography

Transesophageal echocardiography (TEE) is the most common imaging method for evaluating left atrial morphology. Recent advances in 64-slice multidetector computed tomography (64-MDCT) allow accurate measurement of left atrial appendage (LAA) volume. The aim of this study was to evaluate the accuracy of LAA sizing by TEE in comparison with 64-MDCT in patients with atrial fibrillation. Electrocardiogram-gated 64-MDCT and TEE were performed within 2 days in 18 consecutive patients (63 ± 9 years old, 12 males, 5 paroxysmal atrial fibrillation) with nonvalvular atrial fibrillation. LAA area and LAA volume were measured at end-systole by TEE and 64-MDCT, respectively. The largest LAA area was measured on TEE image. Five patients were in sinus rhythm during examinations. In all patients, LAA was clearly visualized; the largest area of LAA was 9.3 ± 3.9 mm² and the LAA volume was 21.6 ± 7.5 ml. A significant correlation between LAA area and LAA volume was observed (p = 0.0003, r = 0.75). TEE allows a detailed evaluation of the LAA structure by two-dimensional imaging. LAA size could be evaluated by TEE despite its morphological complexity, i.e., sac-like or multilobed structure.