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Contrast-enhanced transesophageal echocardiography predicts neo-intimal coverage of device post-left atrial appendage closure
Affiliations- Department of Cardiology, the Third Medical Center, Chinese PLA (People’s Liberation Army) General Hospital, Beijing, China
- Department of Medicine, Division of Cardiology, University of California (Davis) Medical Center, Sacramento, California, United States
- Department of Mechanical and Aerospace Engineering, Hong Kong University of Science and Technology, Hong Kong SAR, China
- Department of Hepatobiliary Surgery, the First Medical Center, Chinese PLA (People’s Liberation Army) General Hospital, Beijing, China
- ShenZhen KYD Biomedical Technology Co. Ltd., China
- ShenZhen Cardiovascular Engineering Laboratory of Drug and Device Development, China
open access
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.
Keywords
left atrial appendage closure, endothelialization, contrast echocardiography, histology, noninvasive surveillance
About this articleTitle
Contrast-enhanced transesophageal echocardiography predicts neo-intimal coverage of device post-left atrial appendage closure
Journal
Issue
Article type
Original Article
Pages
489-498
Published online
2020-09-21
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5324
Article views/downloads
1081
DOI
Pubmed
Bibliographic record
Cardiol J 2022;29(3):489-498.
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
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