open access

Vol 26, No 6 (2019)
Original articles — Clinical cardiology
Published online: 2018-03-02
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Two-dimensional versus three-dimensional transesophageal echocardiography in percutaneous left atrial appendage occlusion

Witold Streb, Katarzyna Mitręga, Tomasz Podolecki, Magdalena Szymała, Anna Leopold-Jadczyk, Tomasz Kukulski, Zbigniew Kalarus
DOI: 10.5603/CJ.a2018.0019
·
Pubmed: 29512094
·
Cardiol J 2019;26(6):687-695.

open access

Vol 26, No 6 (2019)
Original articles — Clinical cardiology
Published online: 2018-03-02

Abstract

Background: Real-time three-dimensional transesophageal echocardiography (RT3D TEE) enables
better visualization of the left atrial appendage (LAA) and may be superior to real-time two-dimensional
transesophageal echocardiography (RT2D TEE) for LAA occlusion (LAAO). The aim of this study was
to assess inter- and intra-observer variability of RT2D TEE and RT3D TEE measurements of LAA,
and to assess the accordance of RT2D TEE and RT3D TEE with appropriate occluder selection.
Methods: Transesophageal echocardiography was performed in 40 patients during LAAO. RT2D
TEE and RT3D TEE measurements of the ostium and landing zone were performed independently by
two echocardiographers. The appropriate choice of occluder was confirmed with fluoroscopic criteria.
After the procedures, RT2D TEE and RT3D TEE evaluation were repeated separately by the same
echocardiographers.
Results: The mean ostium diameters by RT2D TEE obtained by the two observers were 23.6 ± 4.2 vs.
24.8 ± 5.2 (p = 0.04), and the mean landing zone diameters were 17.7 ± 4.4 vs. 19.4 ± 3.9 (p < 0.01).
In the case of RT3D TEE, the ostium diameters were 29.6 ± 5.3 vs. 29.4 ± 6.4 (p = not significant
[NS]) and the landing zone diameters were 21.4 ± 3.8 vs. 21.6 ± 3.9 (p = NS). Intra-observer differences
were absent in the case of RT3D TEE. The comparison of RT2D TEE vs. RT3D TEE analyses
performed by the same echocardiographer revealed significant differences in the ostium and landing
zone measurements (both p < 0.01). Agreement between the suggested device size was better for RT3D
TEE (weighted kappa was 0.62 vs. 0.28, respectively).
Conclusions: The results obtained with RT3D TEE showed significantly larger dimensions of the
ostium and the landing zone. RT3D TEE showed lesser inter- and intra-observer variability and better
agreement with the implanted device.

Abstract

Background: Real-time three-dimensional transesophageal echocardiography (RT3D TEE) enables
better visualization of the left atrial appendage (LAA) and may be superior to real-time two-dimensional
transesophageal echocardiography (RT2D TEE) for LAA occlusion (LAAO). The aim of this study was
to assess inter- and intra-observer variability of RT2D TEE and RT3D TEE measurements of LAA,
and to assess the accordance of RT2D TEE and RT3D TEE with appropriate occluder selection.
Methods: Transesophageal echocardiography was performed in 40 patients during LAAO. RT2D
TEE and RT3D TEE measurements of the ostium and landing zone were performed independently by
two echocardiographers. The appropriate choice of occluder was confirmed with fluoroscopic criteria.
After the procedures, RT2D TEE and RT3D TEE evaluation were repeated separately by the same
echocardiographers.
Results: The mean ostium diameters by RT2D TEE obtained by the two observers were 23.6 ± 4.2 vs.
24.8 ± 5.2 (p = 0.04), and the mean landing zone diameters were 17.7 ± 4.4 vs. 19.4 ± 3.9 (p < 0.01).
In the case of RT3D TEE, the ostium diameters were 29.6 ± 5.3 vs. 29.4 ± 6.4 (p = not significant
[NS]) and the landing zone diameters were 21.4 ± 3.8 vs. 21.6 ± 3.9 (p = NS). Intra-observer differences
were absent in the case of RT3D TEE. The comparison of RT2D TEE vs. RT3D TEE analyses
performed by the same echocardiographer revealed significant differences in the ostium and landing
zone measurements (both p < 0.01). Agreement between the suggested device size was better for RT3D
TEE (weighted kappa was 0.62 vs. 0.28, respectively).
Conclusions: The results obtained with RT3D TEE showed significantly larger dimensions of the
ostium and the landing zone. RT3D TEE showed lesser inter- and intra-observer variability and better
agreement with the implanted device.

Get Citation

Keywords

left atrial appendage occlusion, real-time two- and three-dimensional transesophageal echocardiography, Amplatzer Occluder

About this article
Title

Two-dimensional versus three-dimensional transesophageal echocardiography in percutaneous left atrial appendage occlusion

Journal

Cardiology Journal

Issue

Vol 26, No 6 (2019)

Pages

687-695

Published online

2018-03-02

DOI

10.5603/CJ.a2018.0019

Pubmed

29512094

Bibliographic record

Cardiol J 2019;26(6):687-695.

Keywords

left atrial appendage occlusion
real-time two- and three-dimensional transesophageal echocardiography
Amplatzer Occluder

Authors

Witold Streb
Katarzyna Mitręga
Tomasz Podolecki
Magdalena Szymała
Anna Leopold-Jadczyk
Tomasz Kukulski
Zbigniew Kalarus

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