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Vascular Landmark-Based Method for Highly Reproducible Measurement of Left Atrial Appendage Volume in Computed Tomography.

ABSTRACT: BACKGROUND:Modern computed tomographic scanning can produce 4-dimensional images of the left atrial appendage (LAA). LAA function and morphology can then be measured, to plan interventions such as occlusion and to evaluate LAA flow for thrombogenic risk analysis. A current problem here is defining a reproducible boundary between the LAA and the left atrium. METHODS:This study used retrospectively gated 4-dimensional computed tomographic data from 25 implantation and coronary artery imaging patients. In each patient, the LAA ostium was defined at multiple time points during the RR interval. To examine the reproducibility of the definition of the LAA ostium, 3 observers analyzed all time frames in each patient 3 times. Five nonconsecutive time frames from each patient were then compared using intraclass correlation coefficients to quantify the precision of the method across patients. The correlation of LAA volumes for each time frame of each patient was determined across the different observers (interobserver) and within each observer's own data sets (intraobserver). RESULTS:The method was successful in 92% of patients. Two-way random-effect, absolute-agreement, single-measurement intraclass correlation coefficients for interobserver measurements were 0.984, 0.990, and 0.988, with intraobserver intraclass correlation coefficients of 0.989, 0.989, and 0.995. The intraclass correlation coefficient of all observations was 0.988. CONCLUSIONS:Classification of the LAA ostium using a stepwise procedure identifying the coumadin ridge and 2 vascular landmarks in ECG-gated computed tomography provides a viable method of establishing a highly reproducible boundary between the atrium and LAA needed to obtain LAA metrics useful for procedure planning and measuring LAA function.

SUBMITTER: Schluchter A

PROVIDER: S-EPMC7685054 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Vascular Landmark-Based Method for Highly Reproducible Measurement of Left Atrial Appendage Volume in Computed Tomography.

Schluchter Andrew A Jan Chelsea C Lowe Katherine K Vigneault Davis M DM Contijoch Francisco F McVeigh Elliot R ER

Circulation. Cardiovascular imaging 20191217 12

<h4>Background</h4>Modern computed tomographic scanning can produce 4-dimensional images of the left atrial appendage (LAA). LAA function and morphology can then be measured, to plan interventions such as occlusion and to evaluate LAA flow for thrombogenic risk analysis. A current problem here is defining a reproducible boundary between the LAA and the left atrium.<h4>Methods</h4>This study used retrospectively gated 4-dimensional computed tomographic data from 25 implantation and coronary arter ...[more]

PMID: 31842587

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Project description:BackgroundThe 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.MethodsA 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 sex- and 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.ResultsDecreased 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/m2 (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.ConclusionsDecreased 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.

Dataset Information

Vascular Landmark-Based Method for Highly Reproducible Measurement of Left Atrial Appendage Volume in Computed Tomography.

Publications

Vascular Landmark-Based Method for Highly Reproducible Measurement of Left Atrial Appendage Volume in Computed Tomography.

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