Multimodality approach for endovascular left atrial appendage closure: head-to-head comparison among 2D and 3D echocardiography, angiography and computer tomography

Purpose. Percutaneous left atrial appendage closure (LAAC) requires accurate pre- and intraprocedural measurements and multimodality imaging is an essential tool for guiding the procedure. Two-dimensional (2D TEE) and three-dimensional (3D TEE) transesophageal echocardiography, cardiac computed tomography (CCT) and conventional cardiac angiography (CCA) are commonly used to evaluate left atrial appendage (LAA) size. However, standardized approaches in measurement methods across different imaging modalities are lacking. The aims of the study were to evaluate the LAA dimension and morphology in patients undergoing LAAC and compare data obtained by different imaging modalities: 2D and 3D TEE, CCT and CCA. Methods. A total of 188 patients (mean age 70  8 years, 94 males) were examined by different techniques (161 2D TEE, 103 3D TEE, 98 CCT, 188 CCA). Patients were submitted to preoperatory CCT and intraoperatory 2D and 3D TEE and CCA. Results. Statistical analysis showed a significant correlation for all measurements obtained by different modalities. In particular, we noticed that 3D TEE and CCT measurements were highly correlated with an excellent agreement for the landing zone (LZ) dimensions (r=0.87 for LZ diameter and r=0.91 for LAA depth). Conclusions. Head-to-head comparison among different imaging techniques (2D and 3D TEE, CCT and CCA) shows a good correlation of LZ diameter measured with all imaging modalities, which is a parameter of paramount importance for the choice of device size. In particular, LZ diameter and area by 3D TEE had the best correlation with CCT.

【研究目的】经皮左心耳封堵术（Percutaneous left atrial appendage closure, LAAC）需精准的术前及术中测量，多模态成像是指导该手术的必要工具。临床常用二维经食管超声心动图（2D TEE）、三维经食管超声心动图（3D TEE）、心脏计算机断层扫描（CCT）及常规心脏血管造影（CCA）评估左心耳（LAA）尺寸，但目前不同成像模态间缺乏统一的测量规范。本研究旨在评估接受LAAC手术患者的左心耳尺寸与形态，并对比2D TEE、3D TEE、CCT及CCA四种成像技术获取的相关数据。【研究方法】本研究共纳入188例患者（平均年龄70±8岁，男性94例），分别接受多种成像技术检查：其中161例行2D TEE检查，103例行3D TEE检查，98例行CCT检查，188例行CCA检查。所有患者均完成术前CCT检查，以及术中2D TEE、3D TEE与CCA检查。【研究结果】统计学分析显示，不同成像技术获取的所有测量指标均存在显著相关性。其中，3D TEE与CCT的测量结果相关性极高，二者在封堵着陆区（Landing Zone, LZ）尺寸的一致性极佳：着陆区直径的相关系数r=0.87，左心耳深度的相关系数r=0.91。【研究结论】对2D TEE、3D TEE、CCT及CCA四种成像技术的直接对比表明，所有成像技术测得的封堵着陆区直径均具有良好相关性，而该参数是选择封堵器械尺寸的关键指标。其中，3D TEE测得的封堵着陆区直径与面积与CCT的相关性最优。