Assessment of left atrial appendage volume and function using real-time three-dimensional transesophageal echocardiography in patients with nonvalvular atrial fibrillation

Objective To evaluate the volume and function of left atrial appendage (LAA) in patients with nonvalvular atrial fibrillation using real-time three-dimensional transesophageal echocardiography (RT-3D TEE).Methods Eighty-seven patients underwent RT-3D TEE were divided into 4 groups:patients with normal sinus rhythm group,paroxysmal atrial fibrillation groups with sinus rhythm and with fibrillation,persistent atrial fibrillation group.RT-3D TEE data of left atrial appendage volume and function parameters were derived and analyzed offline with Qlab analysis software.LSD of One-way ANOVA was used to analysis the same parameters among these groups,and Pearson correlation coefficient between ejection fraction (EF) with the other parameters in the fibrillation group were obtained respectively.Results ①The correlation analysis indicated that there was significantly negative correlation between LAA-EF and endsystolic volume (ESV),and there were lower negative correlation among LAA-EF and end-diastolic volume (EDV),LAA maximal area (Amax) and the patients ages.Otherwise,LAA-EF correlated positively with LAA area change percentage (A％),LAA diameter change percentage (D％),and had medium positive correlation with LAA peak emptying velocity(Vep).There was no correlation between LAA-EF and LAA maximal diameter (Dmax).②The change rate of spontaneous echo contrast (SEC) and thrombi of LAA were increasing with duration of atrial fibrillation.③In patients with short-time atrial fibrillation and cardioversion autonomously or after drugs,the enlargement of EDV of the LAA occurred firstly,then ESV,A％ and D％ diminished when drugs was ineffective,lastly,the parameters of volume and contraction declined in patients with persistent atrial fibrillation.Conclusions Quantitative study of the volume and function of LAA by RT-3D TEE,and the relationship between the characteristics of LAA and the duration of atrial fibrillation may offer important information for the evaluation of atrial fibrillation and the choose of treatment protocol. Key words: Echocardiography, transesophageal;  Echocardiography, real-time three-dimensional; Atrial appendage; Atrial fibrillation