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Clinical Significance of the Left Atrial Appendage Orifice Area

OBJECTIVE: The left atrial appendage (LAA) is one of the major sources of cardiac thrombus formation. Three-dimensional transesophageal echocardiography (TEE) made it possible to perform a detailed evaluation of the LAA morphologies. This study aimed to evaluate the clinical implications of the LAA...

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Autores principales: Miki, Yusuke, Uchida, Yasuhiro, Tanaka, Akihito, Tobe, Akihiro, Sakakibara, Keisuke, Kataoka, Takashi, Niwa, Kiyoshi, Furusawa, Kenji, Ichimiya, Hitoshi, Watanabe, Junji, Kanashiro, Masaaki, Ishii, Hideki, Ichimiya, Satoshi, Murohara, Toyoaki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Japanese Society of Internal Medicine 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9259814/
https://www.ncbi.nlm.nih.gov/pubmed/34776484
http://dx.doi.org/10.2169/internalmedicine.8301-21
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author Miki, Yusuke
Uchida, Yasuhiro
Tanaka, Akihito
Tobe, Akihiro
Sakakibara, Keisuke
Kataoka, Takashi
Niwa, Kiyoshi
Furusawa, Kenji
Ichimiya, Hitoshi
Watanabe, Junji
Kanashiro, Masaaki
Ishii, Hideki
Ichimiya, Satoshi
Murohara, Toyoaki
author_facet Miki, Yusuke
Uchida, Yasuhiro
Tanaka, Akihito
Tobe, Akihiro
Sakakibara, Keisuke
Kataoka, Takashi
Niwa, Kiyoshi
Furusawa, Kenji
Ichimiya, Hitoshi
Watanabe, Junji
Kanashiro, Masaaki
Ishii, Hideki
Ichimiya, Satoshi
Murohara, Toyoaki
author_sort Miki, Yusuke
collection PubMed
description OBJECTIVE: The left atrial appendage (LAA) is one of the major sources of cardiac thrombus formation. Three-dimensional transesophageal echocardiography (TEE) made it possible to perform a detailed evaluation of the LAA morphologies. This study aimed to evaluate the clinical implications of the LAA orifice area. METHODS: A total of 149 patients who underwent TEE without significant valvular disease were studied. The LAA orifice area was measured using three-dimensional TEE. The patients were divided into two groups according to the LAA orifice area (large LAA orifice group, ≥median value, and small LAA orifice group). The clinical characteristics and echocardiographic findings were evaluated. RESULTS: The median LAA orifice area among all patients was 4.09 cm(2) (interquartile range 2.92-5.40). The large LAA orifice group were older (67.2±10.4 vs. 62.4±15.3 years, p=0.02), more often had hypertension (66.7% vs. 44.6%, p=0.007), and atrial fibrillation (70.7% vs. 39.2%, p<0.001) than the small LAA orifice group. Regarding the TEE findings, the LAA flow velocity was significantly lower (33.7±20.0 vs. 50.2±24.3, p<0.001) and spontaneous echo contrast was more often observed (21.3% vs. 8.1%, p=0.02) in the large LAA orifice group. Multivariate models demonstrated that atrial fibrillation was an independent predictor of the LAA orifice area. In the analysis of atrial fibrillation duration, the LAA orifice area tended to be larger as patients had a longer duration of atrial fibrillation. CONCLUSION: Our findings indicated that a larger LAA orifice area was associated with the presence of atrial fibrillation and high thromboembolic risk based on TEE findings. A continuation of the atrial fibrillation rhythm might lead to the gradual expansion of the LAA orifice.
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spelling pubmed-92598142022-07-19 Clinical Significance of the Left Atrial Appendage Orifice Area Miki, Yusuke Uchida, Yasuhiro Tanaka, Akihito Tobe, Akihiro Sakakibara, Keisuke Kataoka, Takashi Niwa, Kiyoshi Furusawa, Kenji Ichimiya, Hitoshi Watanabe, Junji Kanashiro, Masaaki Ishii, Hideki Ichimiya, Satoshi Murohara, Toyoaki Intern Med Original Article OBJECTIVE: The left atrial appendage (LAA) is one of the major sources of cardiac thrombus formation. Three-dimensional transesophageal echocardiography (TEE) made it possible to perform a detailed evaluation of the LAA morphologies. This study aimed to evaluate the clinical implications of the LAA orifice area. METHODS: A total of 149 patients who underwent TEE without significant valvular disease were studied. The LAA orifice area was measured using three-dimensional TEE. The patients were divided into two groups according to the LAA orifice area (large LAA orifice group, ≥median value, and small LAA orifice group). The clinical characteristics and echocardiographic findings were evaluated. RESULTS: The median LAA orifice area among all patients was 4.09 cm(2) (interquartile range 2.92-5.40). The large LAA orifice group were older (67.2±10.4 vs. 62.4±15.3 years, p=0.02), more often had hypertension (66.7% vs. 44.6%, p=0.007), and atrial fibrillation (70.7% vs. 39.2%, p<0.001) than the small LAA orifice group. Regarding the TEE findings, the LAA flow velocity was significantly lower (33.7±20.0 vs. 50.2±24.3, p<0.001) and spontaneous echo contrast was more often observed (21.3% vs. 8.1%, p=0.02) in the large LAA orifice group. Multivariate models demonstrated that atrial fibrillation was an independent predictor of the LAA orifice area. In the analysis of atrial fibrillation duration, the LAA orifice area tended to be larger as patients had a longer duration of atrial fibrillation. CONCLUSION: Our findings indicated that a larger LAA orifice area was associated with the presence of atrial fibrillation and high thromboembolic risk based on TEE findings. A continuation of the atrial fibrillation rhythm might lead to the gradual expansion of the LAA orifice. The Japanese Society of Internal Medicine 2021-11-13 2022-06-15 /pmc/articles/PMC9259814/ /pubmed/34776484 http://dx.doi.org/10.2169/internalmedicine.8301-21 Text en Copyright © 2022 by The Japanese Society of Internal Medicine https://creativecommons.org/licenses/by-nc-nd/4.0/The Internal Medicine is an Open Access journal distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Miki, Yusuke
Uchida, Yasuhiro
Tanaka, Akihito
Tobe, Akihiro
Sakakibara, Keisuke
Kataoka, Takashi
Niwa, Kiyoshi
Furusawa, Kenji
Ichimiya, Hitoshi
Watanabe, Junji
Kanashiro, Masaaki
Ishii, Hideki
Ichimiya, Satoshi
Murohara, Toyoaki
Clinical Significance of the Left Atrial Appendage Orifice Area
title Clinical Significance of the Left Atrial Appendage Orifice Area
title_full Clinical Significance of the Left Atrial Appendage Orifice Area
title_fullStr Clinical Significance of the Left Atrial Appendage Orifice Area
title_full_unstemmed Clinical Significance of the Left Atrial Appendage Orifice Area
title_short Clinical Significance of the Left Atrial Appendage Orifice Area
title_sort clinical significance of the left atrial appendage orifice area
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9259814/
https://www.ncbi.nlm.nih.gov/pubmed/34776484
http://dx.doi.org/10.2169/internalmedicine.8301-21
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