Filling defects in the left atrial appendage restricted to the early phase of cardiac computed tomography as a potential risk of left atrial appendage dysfunction

Ouchi, Kotaro; Sakuma, Toru; Higuchi, Takahiro; Yoshida, Jun; Narui, Ryosuke; Nojiri, Ayumi; Yamane, Teiichi; Ojiri, Hiroya

doi:10.1016/j.jjcc.2021.09.011

Cited by 7 publications

(9 citation statements)

References 32 publications

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“…Our study did not find LAA morphology to be associated with early LAA filling defects, which differs from the results reported by Ouchi et al in 2020 (22), who that chicken wing LAA was an independent predictor of LAA filling defects. However, in another recent article, Ouchi et al reported that LAA morphology was not associated with LAA filling defects (11), which is consistent with our study results. These different conclusions may be due to variability among different observers, sampling error, ethnic differences, or differences in the incidence of LAA morphology reported (23,24).…”

Section: Laa Morphologysupporting

confidence: 93%

Factors associated with left atrial appendage filling defects on early-phase cardiac computed tomography in patients with nonvalvular atrial fibrillation: a case-control study

Liu¹,

Tian²,

Hu³

et al. 2023

Quant Imaging Med Surg

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Background: The significance of left atrial appendage (LAA) filling defects on early-phase cardiac computed tomography (CCT) remains uncertain. This study retrospectively investigated predictive factors of LAA filling defects on early-phase CCT.Methods: A total of 68 patients with nonvalvular atrial fibrillation (AF) and early filling defect on CCT who underwent transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were enrolled [48 males, 20 females; mean ± standard deviation (SD) age 62.72±8.13 years]. Additionally 68 sexand age-matched patients with normal LAA filling were included as the control group. CCT, ultrasound, clinical and laboratory data were analyzed. Baseline data between groups were analyzed using t-, Mann-Whitney, and chi-squared tests. Multivariable logistic regression analysis was used to adjust for confounders.Pearson correlation analysis was used to confirm correlations between variables.Results: Decreased LAA flow velocity [LAAFV; odds ratio (OR) =0.918; 95% confidence interval (CI): 0.883-0.954; P<0.001] and increased left atrial volume index (LAVI; OR =1.055; 95% CI: 1.012-1.099; P=0.011) were significantly associated with early-phase CCT LAA filling defects. The LAAFV threshold for predicting early LAA filling defects was 40.5 cm/s, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.905 (sensitivity 82.4%, specificity 91.2%); the LAVI predictive threshold was 58.77 mL/m 2 (AUC =0.840, sensitivity 85.3%, specificity 72.1%). A significant positive correlation was detected between LAAFV and the Hounsfield unit (HU) ratio of the LAA to ascending aorta on early-phase CCT (r=0.614; P<0.001), as well as the HU difference in LAA between early and delayed phase CCT (r=0.591; P<0.001). There were significant (P<0.05) differences in LAAFV between different filling defects.Conclusions: Decreased LAAFV and increased LAVI are independent factors associated with LAA filling defects only on early-phase CCT. Early-phase CCT LAA filling defect is associated with LAA emptying dysfunction. These findings contribute to thrombosis risk stratification in patients with AF.

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Section: Laa Morphologysupporting

confidence: 93%

Factors associated with left atrial appendage filling defects on early-phase cardiac computed tomography in patients with nonvalvular atrial fibrillation: a case-control study

Liu¹,

Tian²,

Hu³

et al. 2023

Quant Imaging Med Surg

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“…In‐group paired comparison: There was a significant difference in LAA depth between the false‐positive group and the true‐positive group and a significant difference in LAA orifice size between the false‐positive group and the true‐negative group, indicating that a false positive is an abnormal condition objectively existing between the true‐positive group and the true‐negative group. Compared with the results of the TEE, which failed to detect positivity at the stage, CT could detect the hemodynamic disorder in LAA earlier and more sensitively; this is consistent with the results of Ouchi et al (2022a).…”

Section: Discussionsupporting

confidence: 89%

“…U R E 5 ROC curve of LAA depth.group and a significant difference in LAA orifice size between the false-positive group and the true-negative group, indicating that a false positive is an abnormal condition objectively existing between the true-positive group and the true-negative group. Compared with the results of the TEE, which failed to detect positivity at the stage, CT could detect the hemodynamic disorder in LAA earlier and more sensitively; this is consistent with the results ofOuchi et al (2022a).As shown in the study, the LAA structure changed continuously in the progression process of AF, leading to different CT manifestations. Due to different imaging principles, CT might be able to detect a hemodynamic disorder in the LAA earlier than TEE, and the combined application of CT + TEE could more accurately evaluate the LAA hemodynamics of patients with AF, providing references for accurate clinical decisions.…”

supporting

confidence: 86%

“…The LAA originates in the LA and grows with the growth of LA, as they are histologically identical (Matsumoto et al, 2017). The change in the anatomic structure of the LA and LAA caused by AF (Burrell et al, 2013; Ouchi et al, 2022a; Pathak et al, 2013) is one of the reasons for the occurrence of hemodynamic disorder and thrombosis in the LAA (Lee et al, 2015). According to some studies, the size of the LA as well as the size and depth of the LAA orifice were negatively correlated with the blood flow rate in the LAA (Chen et al, 2021; Lee et al, 2014, 2015; Matsumoto et al, 2017; Miki et al, 2022; Ouchi et al, 2022b).…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac CTA examination has been widely used for the evaluation of patients before ablation; however, when taking TEE as the gold standard, there exist false-positive results of LAA thrombus and SEC in the CTA evaluation, with unclear clinical significance (Ouchi et al, 2022a). Hioki et al (2016) deemed that the filling defect of LAA on the CT result was associated with thrombus in the LAA and with the decreased blood flow rate in the LAA in patients with AF.…”

Section: Discussionmentioning

confidence: 99%

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Study on the correlation between false‐positive filling defect in LAA CT and LAA structure in patients with atrial fibrillation based on TEE

Guo

Dong

et al. 2022

Noninvasive Electrocardiol

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Objective: This study aims to explore the actual meaning of "false positive filling defect" in left atrial appendage (LAA) computed tomography (CT) in patients with atrial fibrillation (AF), with transesophageal echocardiography (TEE) as the gold standard. Methods:Patients with AF undergoing cardiac CT angiography and TEE examinations for proposed radiofrequency catheter ablation between October 2020 and October 2021 were selected as the study subjects. Transesophageal echocardiography was taken as the "gold standard," and spontaneous echocardiographic contrast (SEC) and thrombus events were defined as positive events. The CT manifestations were classified into three groups (true positive, false positive, and true negative) to evaluate the differences in left atrium (LA) anterior-posterior diameter (LAAP), LA anterior wall thickness, and LAA orifice long diameter and short diameter, area, and depth between the three groups. Results:(1) There was no statistical difference in LA anterior wall thickness between the three groups (p > .05); there was a statistical difference in LAAP (only) between the true-positive group and the true-negative group (p < .05). ( 2) There was a statistical difference in LAA orifice long diameter, short diameter, and area between the true-positive group and the true-negative group as well as between the false-positive group and the true-negative group (p < .05). ( 3) There was a statistical difference in LAA depth between the true-positive group and the false-positive group as well as between the true-positive group and the true-negative group (p < .05). ( 4) The area under the receiver operator characteristic curve (AUC) of LAA depth affecting the LAA thrombus and SEC was 0.863 (confidence interval = 0.718-1.000), the sensitivity was 77.8%, and the specificity was 90.6% for predicting the occurrence of LAA thrombus and SEC in patients with nonvalvular AF (NVAF) and an LAA depth of ≥50.84 mm. Conclusions:There was a difference in LAA diameter between the TEE-based CT false-positive group and the other groups. A "CT false positive" is an objectively existing state, and CT might be able to identify the LAA hemodynamic disorder earlier than How to cite this article:

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Prediction of spontaneous echocardiographic contrast within the left atrial appendage in cardiac computed tomography of patients with atrial fibrillation

et al. 2023

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Filling defects in the left atrial appendage restricted to the early phase of cardiac computed tomography as a potential risk of left atrial appendage dysfunction

Cited by 7 publications

References 32 publications

Factors associated with left atrial appendage filling defects on early-phase cardiac computed tomography in patients with nonvalvular atrial fibrillation: a case-control study

Factors associated with left atrial appendage filling defects on early-phase cardiac computed tomography in patients with nonvalvular atrial fibrillation: a case-control study

Study on the correlation between false‐positive filling defect in LAA CT and LAA structure in patients with atrial fibrillation based on TEE

Prediction of spontaneous echocardiographic contrast within the left atrial appendage in cardiac computed tomography of patients with atrial fibrillation

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