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Published online: 2020-09-21
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Contrast-enhanced transesophageal echocardiography predicts neo-intimal coverage of device post-left atrial appendage closure

Xiaoxia Wu, Dali Fan, Wei Huang, Yuezhi Meng, Tao Wan, Ezra A. Amsterdam, Yejia Shen, Yilong Chen, Dongxing Ma
DOI: 10.5603/CJ.a2020.0125
·
Pubmed: 32986237

open access

Ahead of print
Original articles
Published online: 2020-09-21

Abstract

Background: Left atrial appendage (LAA) closure (LAAC) is a viable alternative to anticoagulation for stroke prevention in non-valvular atrial fibrillation. However, device-associated thrombosis (DAT) is known as a complication of LAAC as observed within the first few weeks after implantation. A noninvasive method is needed to predict the progress for endothelialization surveillance. The aim of the study was to develop a noninvasive visual contrast-enhanced transesophageal echocardiography (cTEE) method for monitoring the communication between left atrium (LA) and LAA post-LAAC by cTEE-score evaluating the contrast enhancement in LAA.

Methods: A total of 29 healthy dogs were studied by LAAC at < 24 h and 1, 2, 3 and 6-months. The LAAC procedure was assessed by TEE with color Doppler flow imaging (CDFI) and contrast imaging. The cTEE score was calculated based on the differential contrast opacification of LA and LAA cavities, the CDFI on the width of peri-device color flow, and that of histology on the level of occluder surface endothelialization in postmortem histological examination. Spearman’s correlation analysis was used to correlate these scores.

Results: The correlation between cTEE and histology scores was superior to that between CDFI and histology scores. The trend of average cTEE score was tracked with that of histology, while that of CDFI was far from that of histology. The correlation coefficient of CDFI and histology scores was not significant (p > 0.05).

Conclusions: The noninvasive visual cTEE is feasible and reliable to monitor communication between the LA and LAA post-LAAC. cTEE is superior to CDFI as a tool in predicting the progress for endothelialization surveillance.

Abstract

Background: Left atrial appendage (LAA) closure (LAAC) is a viable alternative to anticoagulation for stroke prevention in non-valvular atrial fibrillation. However, device-associated thrombosis (DAT) is known as a complication of LAAC as observed within the first few weeks after implantation. A noninvasive method is needed to predict the progress for endothelialization surveillance. The aim of the study was to develop a noninvasive visual contrast-enhanced transesophageal echocardiography (cTEE) method for monitoring the communication between left atrium (LA) and LAA post-LAAC by cTEE-score evaluating the contrast enhancement in LAA.

Methods: A total of 29 healthy dogs were studied by LAAC at < 24 h and 1, 2, 3 and 6-months. The LAAC procedure was assessed by TEE with color Doppler flow imaging (CDFI) and contrast imaging. The cTEE score was calculated based on the differential contrast opacification of LA and LAA cavities, the CDFI on the width of peri-device color flow, and that of histology on the level of occluder surface endothelialization in postmortem histological examination. Spearman’s correlation analysis was used to correlate these scores.

Results: The correlation between cTEE and histology scores was superior to that between CDFI and histology scores. The trend of average cTEE score was tracked with that of histology, while that of CDFI was far from that of histology. The correlation coefficient of CDFI and histology scores was not significant (p > 0.05).

Conclusions: The noninvasive visual cTEE is feasible and reliable to monitor communication between the LA and LAA post-LAAC. cTEE is superior to CDFI as a tool in predicting the progress for endothelialization surveillance.

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Keywords

left atrial appendage closure, endothelialization, contrast echocardiography, histology, noninvasive surveillance

About this article
Title

Contrast-enhanced transesophageal echocardiography predicts neo-intimal coverage of device post-left atrial appendage closure

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2020-09-21

DOI

10.5603/CJ.a2020.0125

Pubmed

32986237

Keywords

left atrial appendage closure
endothelialization
contrast echocardiography
histology
noninvasive surveillance

Authors

Xiaoxia Wu
Dali Fan
Wei Huang
Yuezhi Meng
Tao Wan
Ezra A. Amsterdam
Yejia Shen
Yilong Chen
Dongxing Ma

References (16)
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