Three-dimensional transesophageal echocardiography demonstration of left atrial appendage echocontrast regression after 6 months therapy with dabigatran and not with warfarin

Vestito, Domenico; Desantis, Delia; Colonna, Paolo

doi:10.4103/2211-4122.183751

Cited by 4 publications

(1 citation statement)

References 10 publications

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“…In addition to the reduction or disappearance of thrombus in some patients following anticoagulant therapy, we also observed that in some patients with left atrial or LAA spontaneous echo contrast, the spontaneous echo contrast was disappeared or reduced after anticoagulant therapy. Vestito et al [ 14 ] made a comparative study of the effects of dabigatran and Warfarin on spontaneous echo contrast in LAA of patients with AF, and the results showed that the spontaneous echo contrast was disappeared or reduced in LAA of patients with AF after dabigatran anticoagulant therapy, while after Warfarin anticoagulant therapy, there was no significant change in spontaneous echo contrast. Mahony et al [ 15 ] also observed a decrease in the degree of LA spontaneous echo contrast during antiplatelet therapy.…”

Section: Discussionmentioning

confidence: 99%

Anticoagulation efficacy of dabigatran etexilate for left atrial appendage thrombus in patients with atrial fibrillation by transthoracic and transesophageal echocardiography

Xing

Liu²,

Han³

et al. 2018

Medicine

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To evaluate the anticoagulation efficacy of dabigatran etexilate for left atrial appendage (LAA) thrombus resolution in patients with atrial fibrillation by transthoracic echocardiography and transesophageal echocardiography, and to investigate the anticoagulation factors.A total of 58 atrial fibrillation patients with LAA thrombus in our hospital were enrolled. After dabigatran etexilate anticoagulation for 3 months, the patients were divided into the effective group and ineffective group according to dissolution of thrombosis. The baseline data and the left atrial diameter (LAD), left atrial ejection fraction (LAEF), left ventricular ejection fraction, LAA flow velocity (LAA-v), and LAA thrombus size before and after anticoagulation treatment were recorded, and the measurement index were statistically analyzed.After the patients received anticoagulation treatment for 3 months, 15 patients had complete dissolution, thrombus in 21 patients reduced significantly, and the complete dissolution rate was 25.9% (15/58), the effective rate of dissolution was 62.1% (36/58). Compared with the ineffective group, the proportion of persistent atrial fibrillation and LAD in effective group were lower than those in the ineffective group, the LAEF and LAA-v in the effective group were higher than those in the ineffective group, and the differences were statistically significant (P < .05). Multivariate logistic regression analysis on the baseline data and each ultrasound index showed that the type of atrial fibrillation, LAD, LAEF, and LAA-v were independently associated with the efficacy of anticoagulation (P < .05).Dabigatran etexilate is effective in dissolution of LAA thrombus in patients with atrial fibrillation, and the atrial fibrillation type, LAD, LAEF, and LAA-v are significantly related with the efficacy of anticoagulation.

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Section: Discussionmentioning

confidence: 99%

Anticoagulation efficacy of dabigatran etexilate for left atrial appendage thrombus in patients with atrial fibrillation by transthoracic and transesophageal echocardiography

Xing

Liu²,

Han³

et al. 2018

Medicine

View full text Add to dashboard Cite

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Evaluation of left atrial appendage function and thrombi in patients with atrial fibrillation: from transthoracic to real time 3D transesophageal echocardiography

Dentamaro¹,

Vestito²,

Michelotto³

et al. 2016

Int J Cardiovasc Imaging

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The detection of embolic sources in patients with atrial fibrillation (AF) is important to guide anticoagulant therapy. Two-dimensional transesophageal echocardiography (TEE) is the gold standard to study left atrial appendage (LAA) anatomy and morphology, despite some false-positive diagnosis. We hypothesized that real time 3D TEE (RT3DTEE) is superior to 2DTEE in detecting and/or excluding LAA thrombi. We studied 93 patients with non-valvular AF (60 males, age = 67.1 ± 14.2 years) referred for electric cardioversion with transthoracic, 2DTEE and RT3DTEE. Before cardioversion, TTE allowed a confident measurement of emptying velocity of LAA (LAAeV) only in 59/93 patients (63%). On the contrary a good quality TEE LAAeV was obtained in all patients with 49/93 (53%) dysfunctional LAA (LAAeV < 40 cm/s). A subgroup of 5 patients (7.2% of the 69 effective cardioversion) presented a persistent dysfunction after cardioversion (with LAAeV values of <40 cm/s on the TEE post-CV). TEE allowed to observe a bilobed shape in 45 patients (48.4%) and three lobes in 22 patients (23.7%). In addition, besides to several additional findings, 2DTEE managed to detect thrombi with certainty in 8/93 patients (8.6%). In other 5 cases with diagnostic doubts for thrombi with 2DTEE (5/93 patients: 5.4%), the addition of the RT3DTEE mode allowed to discriminate with certainty the presence of just pectinate muscles in 4 patients RT3DTEE in patients with AF at risk of embolism is feasible, accurate and showed an additional diagnostic capability in the differential diagnosis of selected cases with suspected LAA thrombi.

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Morphological and functional assessment of the left atrial appendage in daily practice: a comprehensive approach using basic and advanced echocardiography with practical tips

Anwar

2024

J Cardiovasc Imaging

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Cardioembolic stroke is the most serious and life-threatening complication of atrial fibrillation (AF), with an associated mortality up to 30% at 12 months. Approximately 47% of thrombi in valvular AF and 91% of thrombi in nonvalvular AF are localized in the left atrial appendage (LAA). Therefore, identification or exclusion of LAA thrombi is critical in many clinical situations. It is essential to assess LAA morphology and function using imaging modalities (particularly echocardiography) before, during, and after interventional procedures such as AF ablation and LAA occlusion. This review article describes the anatomical, physiological, and pathological background of the LAA, followed by an assessment of different echocardiographic modalities. Many practical points are included to improve the diagnostic accuracy and to minimize errors during image acquisition and interpretation. In each clinical scenario where LAA is the crucial target, specific and essential information and parameters are collected.

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Three-dimensional transesophageal echocardiography demonstration of left atrial appendage echocontrast regression after 6 months therapy with dabigatran and not with warfarin

Cited by 4 publications

References 10 publications

Anticoagulation efficacy of dabigatran etexilate for left atrial appendage thrombus in patients with atrial fibrillation by transthoracic and transesophageal echocardiography

Anticoagulation efficacy of dabigatran etexilate for left atrial appendage thrombus in patients with atrial fibrillation by transthoracic and transesophageal echocardiography

Evaluation of left atrial appendage function and thrombi in patients with atrial fibrillation: from transthoracic to real time 3D transesophageal echocardiography

Morphological and functional assessment of the left atrial appendage in daily practice: a comprehensive approach using basic and advanced echocardiography with practical tips

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