Page 20 - Journal of Structural Heart Disease Volume 5, Issue 5

Original Scientific Article
Journal of Structural Heart Disease, October 2019, Volume 5, Issue 5:213-220
DOI: https://doi.org/10.12945/j.jshd.2019.035.18
Assessment of the Dynamism of the Left
Received: October 07, 2018 Accepted: October 17, 2018 Published online: October 2019
Atrial Appendage Dimensions: A Computer
Tomographic Analysis
Mohamed Marwan, MD*, Amina Vaillant, Fabian Ammon, MD, Daniel Bittner, MD, Michaela Hell, MD, Stephan Achenbach, MD
Department of Cardiology, University of Erlangen-Nuremberg, Erlangen, Germany
Abstract
Background: Device sizing prior to left atrial append- age (LAA) closure is currently primarily based on trans- esophageal echocardiographic as well as invasive angiographic measurements, and can be challenging due to the complex and highly variable anatomy of the LAA. Computerized tomography (CT) is a 3-dimension- al imaging modality that is increasingly being used for planning structural heart disease interventions. We as- sessed the variability of the measurements of the LAA ostium in patients with sinus rhythm and atrial fibrilla- tion referred for CT angiography.
Methods: 101 consecutive patients with available ret- rospective spiral acquisitions as well as multiphase re- constructions between 0 to 90% of the peak R-wave to R-wave were included in this analysis. All acquisitions were performed using a third generation dual source system (Somatom Force, Siemens Healthineers, Forch- heim, Germany). Data sets were transferred to dedi- cated Software (Ziostation2, Ziosoft Inc., Tokyo, Japan) which allows dynamic evaluation of the LAA ostium through the different phases of the cardiac cycle. Mul- tiplanar reconstructions were aligned with the plane of the LAA ostium and measurements where performed in a cross-sectional plane orthogonal to the long axis of the LAA at the level of the left circumflex coronary artery. Four measurements were performed: area, circumfer- ence, area-derived diameter (√[area/∏] x 2) and circum- ference-derived (perimeter/∏). Furthermore assessment of the length if the LAA was assessed in all patients.
Results: Out of 101 patients (mean age 81 ± 8 years, 61% males), 48 patients were in sinus rhythm at time of acquisition and 53 patients were in atrial fibrillation. The mean area of the LAA ostium as well as perimeter were significantly larger in AF patients compared to SR patients (464±153 vs. 359±131 mm2 and 78±12 mm vs. 69±12 mm for AF vs SR patients, respectively, p=0.001). Consequently the area derived diameter as well as pe- rimeter derived diameter were consequently signifi- cantly larger in AF vs. SR patients (24±4 mm vs. 21±4 mm and 25±4 vs. 22±4 mm for area-derived vs. perim- eter-derived diameter, respectively, p<0.001). The per- centage difference between maximal and minimal LAA dimensions were significantly higher for sinus rhythm patients compared to atrial fibrillation [88% (IQR 60; 147%) vs. 21% (IQR 13; 42%), respectively, p<0.001] for median percentage area change and 34% vs. 10% for median percentage perimeter change (IQR 25; 52 vs. 7;18%, respectively, p<0.001).
For atrial fibrillation patients, the largest LAA dimen- sions (area, perimeter, area-derived and perimeter-de- rived diameters) was measured at an average of 40% of the peak R-wave to R-wave whereas for sinus rhythm patients, the maximal LAA dimensions were measured at an average of 46% of the peak R-wave to R-wave (p>0.05). The mean length of the LAA was significant- ly larger in AF patients compared to SR patients (19.5 mm vs. 17 mm for AF vs SR patients, p=0.04) and the median percentage change in length was significantly higher in SR vs. AF (32% [IQR 19; 61%] vs. 13% [IQR 9; 19%] for SR vs. AF patients)
* Corresponding Author:
Mohamed Marwan, MD
Department of Cardiology
University of Erlangen-Nuremberg
Ulmenweg 18, D-91054 Erlangen, Germany
Tel. +49 9131 85 35301; Fax: +49(0)9131 35303; E-Mail: mohamed.marwan@uk-erlangen.de
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2019 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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