Left atrial appendage morphology is closely associated with specific echocardiographic flow pattern in patients with atrial fibrillation

TY - JOUR

T1 - Left atrial appendage morphology is closely associated with specific echocardiographic flow pattern in patients with atrial fibrillation

AU - Petersen, Margot

AU - Roehrich, Adalbert

AU - Balzer, Jan

AU - Shin, Dong-In

AU - Meyer, Christian

AU - Kelm, Malte

AU - Kehmeier, Eva S

N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

PY - 2015/4

Y1 - 2015/4

N2 - AIMS: To assess the relation between left atrial appendage (LAA) morphology and echocardiographic flow pattern of the LAA by means of two- and three-dimensional transoesophageal echocardiography (3D-TEE).METHODS AND RESULTS: In a total of 131 patients with atrial fibrillation, LAA morphology was analyzed by 3D-TEE and classified into four types (Chicken Wing, Windsock, Cactus, Cauliflower). Left atrial appendage flow pattern as maximal LAA emptying flow velocity and spontaneous echo contrast (SEC) were retrieved from 2D-TEE imaging in all patients. In patients with atrial fibrillation (AF), Chicken Wing morphology was associated with a higher LAA emptying flow velocity (difference of means = -11.7, 95% CI 4.6-19.3, P = 0.003) and a reduced prevalence of SEC (OR 3.2, 95% CI 1.1-9.3, P = 0.025) compared with all other LAA types (so-called 'Non-Chicken Wing' LAA). These alterations were irrespective of the underlying type of AF.CONCLUSION: Non-Chicken Wing LAA morphologies are associated with a specific echocardiographic flow pattern in patients with AF. Since evidence exists that LAA flow pattern are indicative of an enhanced risk of thrombus formation, 3D-TEE might be a valuable tool warranting future studies to test whether these morphological and functional characteristics permit risk stratification in AF.

AB - AIMS: To assess the relation between left atrial appendage (LAA) morphology and echocardiographic flow pattern of the LAA by means of two- and three-dimensional transoesophageal echocardiography (3D-TEE).METHODS AND RESULTS: In a total of 131 patients with atrial fibrillation, LAA morphology was analyzed by 3D-TEE and classified into four types (Chicken Wing, Windsock, Cactus, Cauliflower). Left atrial appendage flow pattern as maximal LAA emptying flow velocity and spontaneous echo contrast (SEC) were retrieved from 2D-TEE imaging in all patients. In patients with atrial fibrillation (AF), Chicken Wing morphology was associated with a higher LAA emptying flow velocity (difference of means = -11.7, 95% CI 4.6-19.3, P = 0.003) and a reduced prevalence of SEC (OR 3.2, 95% CI 1.1-9.3, P = 0.025) compared with all other LAA types (so-called 'Non-Chicken Wing' LAA). These alterations were irrespective of the underlying type of AF.CONCLUSION: Non-Chicken Wing LAA morphologies are associated with a specific echocardiographic flow pattern in patients with AF. Since evidence exists that LAA flow pattern are indicative of an enhanced risk of thrombus formation, 3D-TEE might be a valuable tool warranting future studies to test whether these morphological and functional characteristics permit risk stratification in AF.

KW - Atrial Appendage/diagnostic imaging

KW - Atrial Fibrillation/complications

KW - Blood Flow Velocity

KW - Echocardiography, Three-Dimensional/methods

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Reproducibility of Results

KW - Sensitivity and Specificity

KW - Thrombosis/diagnostic imaging

U2 - 10.1093/europace/euu347

DO - 10.1093/europace/euu347

M3 - SCORING: Journal article

C2 - 25491111

VL - 17

SP - 539

EP - 545

JO - EUROPACE

JF - EUROPACE

SN - 1099-5129

IS - 4

ER -