Korean Circ J.  2019 Feb;49(2):173-180. 10.4070/kcj.2018.0152.

Benefit of Four-Dimensional Computed Tomography Derived Ejection Fraction of the Left Atrial Appendage to Predict Thromboembolic Risk in the Patients with Valvular Heart Disease

• Kim IC
• Chang HJ
• Cho IJ
• Shim CY
• Hong GR
• Heo JH
• Nam HS
• Kim YJ
• Choi BW
• Chung N

• KMID: 2432135
• DOI: http://doi.org/10.4070/kcj.2018.0152

Abstract

BACKGROUND AND OBJECTIVES
Decreased left atrial appendage (LAA) emptying velocity in transesophageal echocardiography (TEE) is related with higher incidence of thrombus and increased risk of stroke. Patients with valve disease are at higher risk of thrombus formation before and after surgery. The aim of this study was to investigate the role of 4-dimensional cardiac computed tomography (4DCT) to predict the risk of thrombus formation.
METHODS
Between March 2010 to March 2015, total of 62 patients (mean 60±15 years old, male: 53.2%) who underwent 4DCT and TEE for cardiac valve evaluation before surgery were retrospectively included in the current study. Fractional area change in TEE view and emptying velocity at left atrial appendage in TEE view (VeTEE) were measured. Ejection fraction (EF) of left atrial appendage in computed tomography (EFCT) was calculated by 4DCT with full volume analysis. The best cut-off value of EFCT predicting presence of spontaneous echo contrast (SEC) or thrombus was evaluated, and correlation between the parameters were also estimated.
RESULTS
SEC or thrombus was observed in 45.2%. EFCT and VeTEE were significantly correlated (r=0.452, p < 0.001). However, fractional area change measured by TEE showed no correlation with VeTEE (r=0.085, p=0.512). EFCT < 37.5% best predicted SEC or thrombus in the patients with valve disease who underwent 4DCT and TEE (area under the curve, 0.654; p=0.038).
CONCLUSIONS
In the patients who underwent 4DCT for cardiac valve evaluation before surgery, EFCT by volume analysis might have additional role to evaluate LAA function and estimate the risk of thrombus.

Keyword

Computed tomography; Atrial appendage; Thrombus

MeSH Terms

Atrial Appendage*
Echocardiography, Transesophageal
Four-Dimensional Computed Tomography*
Heart Valve Diseases*
Heart Valves
Humans
Incidence
Male
Retrospective Studies
Stroke
Thrombosis

Figure

• 

  Figure 1 Representative image showing measurement of EFCT (A) and FACTEE (B). BP = blood pressure; EF = ejection fraction; EFCT = ejection fraction of left atrial appendage in computed tomography; FAC = fractional area change; FACTEE = fractional area change in transesophageal echocardiography view; LAA, = left atrial appendage; TEE = transesophageal echocardiography; 4DCT = 4-dimensional cardiac computed tomography.

• 

  Figure 2 Correlation graph of EFCT and FACTEE (A) and EFCT and VeTEE (B). EFCT = ejection fraction of left atrial appendage in computed tomography; FACTEE = fractional area change in transesophageal echocardiography view; LAA = left atrial appendage; VeTEE = emptying velocity at left atrial appendage in transesophageal echocardiography view.

• 

  Figure 3 Receiver operator characteristics curve presenting best cut-off value of EFCT predicting SEC or thrombus (A) and VeTEE <55 cm/s (B). AUC = area under the curve; EF= ejection fraction; EFCT = ejection fraction of left atrial appendage in computed tomography; LAA = left atrial appendage; NPV = negative predicative value; PPV = positive predicative value; SEC = spontaneous echo contrast; VeTEE = emptying velocity at left atrial appendage in transesophageal echocardiography view.

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