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Volume 11 Issue 1
Jan.  2020
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Ge LIU, Tao CHEN, Yang MU, Bao-shi HAN, Hang ZHU, Qi WANG, Yu-tao GUO, Yun-dai CHEN, Jun GUO. Value of Three Imaging Modalities for the Size Selection of Left Atrial Appendage Closure Device[J]. Medical Journal of Peking Union Medical College Hospital, 2020, 11(1): 21-26. DOI: 10.3969/j.issn.1674-9081.20190196
Citation: Ge LIU, Tao CHEN, Yang MU, Bao-shi HAN, Hang ZHU, Qi WANG, Yu-tao GUO, Yun-dai CHEN, Jun GUO. Value of Three Imaging Modalities for the Size Selection of Left Atrial Appendage Closure Device[J]. Medical Journal of Peking Union Medical College Hospital, 2020, 11(1): 21-26. DOI: 10.3969/j.issn.1674-9081.20190196
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Value of Three Imaging Modalities for the Size Selection of Left Atrial Appendage Closure Device

  • Department of Cardiology, The First Medical Center of People's Liberation Army General Hospital, Beijing 100853, China

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  • Corresponding author:

    GUO Jun Tel: 86-10-55499311, E-mail:guojun301@hotmail.com

  • Received Date: September 15, 2019
  • Issue Publish Date: January 29, 2020
    Graphical Abstract
    • Abstract
  •   Objective  The aim of this study was to primarily explore the value of CT angiography (CTA), transesophageal echocardiography (TEE), and intraoperative digital subtraction angiography (DSA) in measuring the orifice diameter of the left atrial appendage for selecting the appropriate size of a closure device.
      Methods  Clinical data of patients with non-valvular atrial fibrillation who underwent percutaneous left atrial appendage closure from December 1, 2015 to March 31, 2019 in The First Medical Center of People'sLiberation Army General Hospital were retrospectively collected. The orifice diameters of left atrial appendage were measured by CTA, TEE, and DSA simultaneously; the size of the device was recorded. The relationship between the measurement result of either method and the device size was analyzed using Pearson's correlation, and the Bland-Altman analysis was used to assess the concordance between the measurement of each method and the device size.
      Results  Totally 102 patients meeting the inclusive and exclusive criteria were enrolled in this study. All patients received successful implantation of left atrial appendage device, with the mean age of (70.1±9.8)years, the CHA2DS2-VASc score (estimatiing the stroke risk for nonvalvular atrial fibrillation in adults) of 5.11±1.43, and the HAS-BLED score (assessing the bleeding risk) of 3.61±1.18. There was no significant difference in the diameter measurement of the left atrial appendage orifice between CTA and DSA[(22.51±3.55)mm vs. (22.22±3.73)mm, q=0.81, P=0.12]; while both measurements were greater than that of TEE[(20.82±3.63)mm, both P < 0.01]. There were good correlations between the CTA, DSA, TEE, and device size (r=0.93, 0.87, 0.83, respectively, all P < 0.01). In the Bland-Altman plots, the narrowest limits of agreement were shown in the correlation of the device size and CTA measurements (-7.83 mm, -2.56 mm), the difference was (-5.19±1.35)mm, and the 95% confidence interval was (-5.46 mm, -4.93 mm); while the widest was in the correlation of the device size and TEE measurements (-11.00 mm, -2.77 mm), the difference was (-6.88±2.10)mm, and the 95% confidence interval was (-7.29 mm, -6.47 mm).
      Conclusion  s For the selection of WATCHMAN closure device, CTA, DSA, and TEE might provide valuable reference measurements. Among the three imaging modalities, the relevance and concordance of CTA measurements are the best.
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    • References (18)
  • [1]
    Sievert H, Lesh MD, Trepels T, et al. Percutaneous left atrial appendage transcatheter occlusion to prevent stroke in high-risk patients with atrial fibrillation:early clinical experience[J]. Circulation, 2002, 105:1887-1889. DOI: 10.1161/01.CIR.0000015698.54752.6D
    [2]
    Cresti A, García-Fernández MA, Sievert H, et al. Prevalence of extra-appendage thrombosis in non-valvular atrial fibrillation and atrial flutter in patients undergoing cardioversion:a large transoesophageal echo study[J]. EuroIntervention, 2019, 15:e225-e230. DOI: 10.4244/EIJ-D-19-00128
    [3]
    Go AS, Hylek EM, Borowsky LH, et al. Warfarin use among ambulatory patients with nonvalvular atrial fibrillation:the anticoagulation and risk factors in atrial fibrillation (ATRIA) study[J]. Ann Intern Med, 1999, 131:927-934. https://www.ncbi.nlm.nih.gov/pubmed/10610643
    [4]
    Holmes DR, Reddy VY, Turi ZG, et al. Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation:a randomised non-inferiority trial[J]. Lancet, 2009, 374:534-542. DOI: 10.1016/S0140-6736(09)61343-X
    [5]
    Wunderlich NC, Beigel R, Swaans MJ, et al. Percutaneous interventions for left atrial appendage exclusion:options, assessment, and imaging using 2D and 3D echocardiography[J]. JACC Cardiovasc Imaging, 2015, 8:472-488. DOI: 10.1016/j.jcmg.2015.02.002
    [6]
    Chow DH, Bieliauskas G, Sawaya FJ, et al. A comparative study of different imaging modalities for successful percutaneous left atrial appendage closure[J]. Open Heart, 2017, 4:e000627. DOI: 10.1136/openhrt-2017-000627
    [7]
    Wang Y, Di BL, Horton RP, et al. Left atrial appendage studied by computed tomography to help planning for appendage closure device placement[J]. J Cardiovasc Electrophysiol, 2010, 21:973-982. DOI: 10.1111/j.1540-8167.2010.01814.x
    [8]
    Rajwani A, Nelson AJ, Shirazi MG, et al. CT sizing for left atrial appendage closure is associated with favourable outcomes for procedural safety[J]. Eur Heart J Cardiovasc Imaging, 2017, 18:1361-1368. DOI: 10.1093/ehjci/jew212
    [9]
    Reddy VY, Doshi SK, Sievert H, et al. Percutaneous left atrial appendage closure for stroke prophylaxis in patients with atrial fibrillation:2.3-Year Follow-up of the PROTECT AF (Watchman Left Atrial Appendage System for Embolic Protection in Patients with Atrial Fibrillation) Trial[J]. Circulation, 2013, 127:720-729. DOI: 10.1161/CIRCULATIONAHA.112.114389
    [10]
    Boersma LV, Ince H, Kische S, et al. Evaluating real-world clinical outcomes in atrial fibrillation patients receiving the WATCHMAN left atrial appendage closure technology[J]. Circ Arrhythm Electrophysiol, 2019, 12:e006841. https://pubmed.ncbi.nlm.nih.gov/30939908/
    [11]
    毕文静, 孙菲菲, 任卫东, 等.应用实时三维经食管超声心动图评价非瓣膜性心房颤动患者左心耳形态和功能[J].中国医学影像技术, 2013, 29:1616-1620. http://qikan.cqvip.com/Qikan/Article/Detail?id=47458607
    [12]
    Saw J, Fahmy P, Spencer R, et al. Comparing measure-ments of CT angiography, TEE, and fluoroscopy of the left atrial appendage for percutaneous closure[J]. J Cardiovasc Electrophysiol, 2016, 27:414-422. DOI: 10.1111/jce.12909
    [13]
    Goitein O, Fink N, Guetta V, et al. Printed MDCT 3D models for prediction of left atrial appendage (LAA) occluder device size:a feasibility study[J]. EuroIntervention, 2017, 13:e1076-e1079. DOI: 10.4244/EIJ-D-16-00921
    [14]
    孟庆国, 尹立雪, 曾杰, 等.三维经食管超声心动图与其他影像技术指导左心耳封堵术的对比[J].中国医学影像技术, 2017, 33:365-369. http://www.cnki.com.cn/Article/CJFDTOTAL-ZYXX201703017.htm
    [15]
    余正春, 马小静, 夏娟, 等.经食管超声心动图及CT在左心耳封堵术前检查中的应用价值[J].中国临床医学影像杂志, 2017, 28:105-108. http://www.cnki.com.cn/Article/CJFDTotal-LYYX201702009.htm
    [16]
    Lewalter T, Ibrahim R, Albers B, et al. An update and current expert opinions on percutaneous left atrial appendage occlusion for stroke prevention in atrial fibrillation[J]. Europace, 2013, 15:652-656. DOI: 10.1093/europace/eut043
    [17]
    Chue CD, de Giovanni J, Steeds RP. The role of echocardiography in percutaneous left atrial appendage occlusion[J]. Eur J Echocardiogr, 2011, 12:i3-i10. DOI: 10.1093/ejechocard/jer090
    [18]
    Lindner S, Behnes M, Wenke A, et al. Relation of left atrial appendage closure devices to topographic neighboring structures using standardized imaging by cardiac computed tomography angiography[J]. Clin Cardiol, 2019, 42:264-269. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6712306/
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