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Minerva Cardioangiologica 2020 Jul 10

DOI: 10.23736/S0026-4725.20.05215-9


lingua: Inglese

Left atrial appendage morphology at transesophageal echocardiography: how to improve reproducibility?

Matteo ANSELMINO 1, Simone FREA 1, Sebastiano GILI 2, Chiara ROVERA 3 , Mara MORELLO 1, Marcella JORFIDA 1, Julien TEODORI 1, Jacopo PERVERSI 4, Ilaria SALVETTI 1, Walter GROSSO MARRA 5, Riccardo FALETTI 6, Dorico RIGHI 6, Fiorenzo GAITA 1, Gaetano M. DE FERRARI 1

1 Division of Cardiology, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” Hospital, University of Turin, Turin, Italy; 2 Interventional Cardiology Unit 3, Monzino IRCCS Cardiac Center, Milan, Italy; 3 Division of Cardiology, Ospedale Civico di Chivasso, Chivasso, Turin, Italy; 4 Division of Cardiology, Ospedale Cardinal Massaia, Asti, Italy; 5 Division of Cardiology, Ospedale Civile di Ivrea, Ivrea, Turin, Italy; 6 Division of Radiology, Department of Diagnostic Imaging and Radiotherapy, University of Turin, Turin, Italy


BACKGROUND: Left atrial appendage (LAA) morphology, investigated by computed tomography and magnetic resonance imaging, has proved to relate to the risk of cerebrovascular events in patients with Atrial Fibrillation (AF). Aim of the present study was to assess reproducibility of Transesophageal Echocardiography (TEE) imaging in describing LAA morphology.
METHODS: Two hundred consecutive patients referred for TEE were enrolled. In the first group of 47 (23.5%) patients LAA morphology was analyzed by conventional TEE and described as Chicken Wing, Windsock, Cactus or Cauliflower. In the second group of 153 (76.5%) patients, instead, a 3D-Xplane diagnostic algorithm was performed to stratify LAA morphology as Linear (Chicken Wing) or Complex (Windsock/Cactus and Cauliflower). Interobserver variability within three independent readers was assessed in both groups of patients and stratified by operator’s experience and training. In a subgroup of 19 (12.4%) patients agreement of LAA morphology description by 3D-Xplane diagnostic algorithm was compared to cardiac magnetic resonance.
RESULTS: By conventional TEE the agreement among operators on LAA morphology classification was poor (ρ<0.13). The 3D-XPlane diagnostic algorithm, instead, significantly increased interobserver agreement up to ρ=0.32 within all readers and up to ρ=0.82 among the experienced and specifically trained operators. LAA morphology description in this latter group provided strong agreement with cardiac magnetic resonance (up to ρ=0.77).
CONCLUSIONS: LAA morphology assessment is challenging by conventional TEE. To improve reproducibility, the use of the 3D-Xplane technique combined with a specific diagnostic algorithm and training of the operators is fundamental.

KEY WORDS: Left atrial appendage; Echocardiography; Transesophageal; Thromboembolic risk

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