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Ito T, Suwa M. Assessment of left atrial appendage function by echocardiography. Heart Fail Rev 2023:10.1007/s10741-023-10298-2. [PMID: 36800057 DOI: 10.1007/s10741-023-10298-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 02/18/2023]
Abstract
The left atrial appendage (LAA) is considered not only to be the most frequent site of thrombus formation, but also to play a pivotal role in maintaining normal cardiac function. Transesophageal echocardiography (TEE) is widely used to assess LAA function. The LAA flow velocity has been used as a surrogate for LAA function, and it varies with multiple interrelated factors including age, hemodynamics, type of arrhythmia, and antiarrhythmic interventions. Relatively great importance of LAA function is involved with intraatrial thrombus formation and subsequent thromboembolism, and thus, understanding of characteristics and behaviors of the LAA under various clinical conditions may help determine strategies against atrial thrombosis. Also, techniques other than TEE-derived Doppler to assess LAA function, such as tissue Doppler imaging, have been proposed. In this review, we introduce clinical and echocardiographic correlates of LAA function, the LAA flow velocity in particular, its significance, and how to interpret functional patterns of the LAA each relevant to specific clinical settings.
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Affiliation(s)
- Takahide Ito
- Department of Cardiology, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Michihiro Suwa
- Cardiovascular Division, Hokusetsu General Hospital, Takatsuki, Japan
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2
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Liu B, Wang Y, Liu Y, Wu P, Li T. Effects of percutaneous balloon mitral valvuloplasty in patients with mitral stenosis and atrial fibrillation: a systematic review and meta-analysis. Acta Cardiol 2022; 77:890-899. [PMID: 34866553 DOI: 10.1080/00015385.2021.1989837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The study aimed to systematically review the existing literature and assess the effects of percutaneous balloon mitral valvuloplasty (PBMV) in patients with mitral stenosis and atrial fibrillation (AF) as opposed to sinus rhythm (SR). METHODS Eligible studies were identified from six electronic databases before June 2021. The primary outcome was mitral valve area (MVA), and secondary outcomes were hemodynamic measurements, in-hospital complications, and long-term outcomes. Relative risks (RRs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were used as effect sizes. RESULTS Fifteen studies were included involving 6351 patients. For the primary outcome, the AF group obtained less favourable changes in MVA (WMD: -0.10, 95%CI: -0.14, -0.06) and a significantly smaller postoperative and long-term MVA (WMD: -0.13, 95%CI: -0.18, -0.08 and WMD: -0.10, 95%CI: -0.17, -0.03, respectively) compared to the SR group. For secondary outcome, the AF group was associated with suboptimal outcomes as following (WMD/RR, [95%CI]): higher LAP (1.37, [0.86, 1.87]), more embolism (2.85, [1.44, 5.63]), lower event-free survival (0.89, [0.80, 1.00]), higher incidences of mitral valve replacement (2.20, [1.40, 3.46]), re-PBMV (2.28, [1.63, 3.19]), and mortality (3.28, [2.42, 4.44]). No significant differences were found in other outcomes. CONCLUSIONS The currently available evidence suggests that PBMV may be less effective in patients with AF than in those with SR. However, early treatment and appropriate management of AF patients undergoing PBMV may benefit the immediate and long-term outcomes.
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Affiliation(s)
- Bojiang Liu
- Heart Central, Third Central Hospital of Tianjin, Tianjin, China
| | - Yunyun Wang
- Heart Central, Third Central Hospital of Tianjin, Tianjin, China
| | - Yingwu Liu
- Heart Central, Third Central Hospital of Tianjin, Tianjin, China
| | - Peng Wu
- Heart Central, Third Central Hospital of Tianjin, Tianjin, China
| | - Tong Li
- Heart Central, Third Central Hospital of Tianjin, Tianjin, China
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Samaan AA, Hassan A, Hassan M, Said K, El Aroussy W, Fawzy ME, Yacoub M. Left atrial structural and functional remodeling following balloon mitral valvuloplasty. Int J Cardiovasc Imaging 2020; 37:999-1007. [PMID: 33211239 DOI: 10.1007/s10554-020-02084-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/21/2020] [Indexed: 11/28/2022]
Abstract
Mitral stenosis (MS) is associated with left atrial (LA) functional and morphological changes as a result of chronic increase in LA pressure. Relieving the mitral obstruction via balloon mitral valvuloplasty (BMV) might be associated with LA structural and functional remodeling. To study alterations of LA volume and functions 1 year following successful BMV in patients with isolated rheumatic severe mitral stenosis. Thirty patients (median age 33 years, 22 women) with severe rheumatic MS were included in the study. Using biplane method, trans-thoracic 2D echocardiography was used to estimate LA volume indexed to body surface area (BSA). Maximal, minimal and pre-A left atrial volumes were measured and indexed to BSA. LA volumetric functions were then assessed and the measurements were repeated 6 months and 1 year after successful valvuloplasty. At baseline, median mitral valve area (MVA) was 0.9 (0.6-1.3) cm2 measured by planimetry with a mean pressure gradient of 12.5 (8-24) mmHg. Following BMV, a significant regression of left atrial volume index was noticed at 6 months compared to baseline (51 vs. 60 ml/m2, p = 0.001) with a further decrease at 1 year (48 vs. 51 ml/m2, p = 0.03). At 6 months, volumetric assessment of left atrial functions showed a significant improvement in LA total emptying fraction (42% vs 30%, p = 0.001) as well as in LA passive emptying fraction (26% vs 14%, p = 0.033) and LA active emptying fraction (20% vs. 18%, p = 0.016). All these indices showed further improvement at 1 year [47% (P = 0.02), 29% (p = 0.03) and 31% (p = 0.001) respectively]. In patients with isolated rheumatic MS, mitral valvuloplasty was associated with a significant decline of LA volume accompanied by a significant improvement of its volumetric functions.
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Affiliation(s)
- Amir Anwar Samaan
- Department of Cardiovascular Medicine, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt. .,Department of Cardiology, Aswan Heart Centre, Aswan, Egypt.
| | - Ahmed Hassan
- Department of Cardiovascular Medicine, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt.,Department of Cardiology, Aswan Heart Centre, Aswan, Egypt
| | - Mohamed Hassan
- Department of Cardiovascular Medicine, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt.,Department of Cardiology, Aswan Heart Centre, Aswan, Egypt
| | - Karim Said
- Department of Cardiovascular Medicine, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Wafaa El Aroussy
- Department of Cardiovascular Medicine, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Eid Fawzy
- Department of Cardiovascular Medicine, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Magdi Yacoub
- Department of Cardiothoracic Surgery, Aswan Heart Centre, Aswan, Egypt.,Department of Cardiothoracic Surgery, Imperial College London, London, UK
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Pourkia R, Panahi M, Emkanjoo Z, Parsaee M, Shojaeifard M, Sattartabar B, Rezaei Y, Samiei N. Morphologic and functional features of left atrial appendage in Iranian population: an echocardiographic study. J Cardiovasc Thorac Res 2019; 11:230-236. [PMID: 31579464 PMCID: PMC6759618 DOI: 10.15171/jcvtr.2019.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 08/02/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction: Cardioembolic events are accompanied by left atrial appendage (LAA) in patients suffering from atrial fibrillation (AF); therefore, the LAA closure is implemented as a preventive strategy. The detection of LAA morphologies and function is a paramount step before establishing the LAA closure. Herein, we sought to determine the morphologic features of the LAA in an Iranian population using echocardiographic evaluation.
Methods: Seventy-two near-normal heart patients were investigated by conducting a cross-sectional study. All patients were examined using the 2-dimensional and 3-dimensional transesophageal echocardiography (2D- and 3D-TEE) method. The anatomical features and functions of LAA were examined. All images were stored and analyzed offline.
Results: The patients’ mean age was 39 ± 15.5 year and 33 (45.8%) were female. The most frequent shape of LAA was wind sock . More LAA lobes was observed in patients with AF compared to those with NSR. In comparison with AF group, the NSR had higher LAA flow velocity (P < 0.01). The paroxysmal AF had greater LAA flow velocity and LAA ejection fraction in comparison with the chronic AF (39 ± 19 vs. 75 ± 22, P < 0.01; and 49±4 vs. 72±14, P < 0.003; respectively). The paroxysmal AF had smaller systolic LAA orifice area in comparison with the chronic AF (P < 0.02).
Conclusion: The morphologic features of LAA in Iranian population were within the range of other studies and LAA length and orifice diameters in 2D- and 3D-TEE were consistent. In addition, AF influenced the morphologies and functions of LAA compared to sinus rhythm.
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Affiliation(s)
- Roghayeh Pourkia
- Echocardiography Research center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahsa Panahi
- Echocardiography Research center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Emkanjoo
- Cardiac Electrophysiology Research Center, Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mozhgan Parsaee
- Cardiac Electrophysiology Research Center, Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Shojaeifard
- Cardiac Electrophysiology Research Center, Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Yousef Rezaei
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Niloufar Samiei
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Ando T, Holmes AA, Slovut DP, Taub CC. Impact of transcatheter aortic valve implantation on left atrial appendage flow velocities. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:375-382. [PMID: 26875747 DOI: 10.1002/jcu.22347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 12/17/2015] [Accepted: 01/21/2016] [Indexed: 06/05/2023]
Abstract
PURPOSE Left atrial appendage (LAA) flow velocity has not been extensively studied in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). The aim of this study was to assess the impact of TAVI on LAA flow velocity. METHODS Medical records of consecutive TAVI recipients were reviewed retrospectively. Patients with persistent atrial fibrillation were excluded. LAA velocities were measured before and after TAVI by transesophageal echocardiography. RESULTS Sixty-one patients were included. Mean LAA emptying (EV) and filling (FV) flow velocity before TAVI were 33 ± 16 cm/s and 31 ± 14 cm/s, respectively. They increased to 37 ± 20 (p = 0.0036) and 33 ± 13 cm/s (p = 0.047) after TAVI in the whole population sample, but not in patients with normal flow AS. In low-flow, low-gradient (LFLG) AS patients, EV and FV increased from 36 ± 22 to 47 ± 30 cm/s (p < 0.01), and from 29 ± 12 to 40 ± 15 cm/s (p < 0.01), respectively, after TAVI. There was no difference between normal flow and LFLG AS patients in the number of patients who achieved EV ≥ 40 cm/s post-TAVI (35% versus 47%, p = 0.54, respectively). CONCLUSIONS LAA EV and FV were low prior to TAVI and increased significantly after TAVI only in patients with LFLG AS. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:375-382, 2016.
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Affiliation(s)
- Tomo Ando
- Department of Internal Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY, 10003
| | - Anthony A Holmes
- Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, 10467
| | - David P Slovut
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, 10467
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, 10467
| | - Cynthia C Taub
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, 10467
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