Benefit of four-dimensional computed tomography derived ejection fraction of the left atrial appendage to predict thromboembolic risk in the patients with valvular heart disease

In Cheol Kim, Hyuk Jae Chang, In Jeong Cho, Chi Young Shim, Geu Ru Hong, Ji Hoe Heo, Hyo Suk Nam, Young Jin Kim, Byoung Wook Choi, Namsik Chung

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background and Objectives: Decreased left atrial appendage (LAA) emptying velocity in transesophageal echocardiography (TEE) is related with higher incidence of thrombus and increased risk of stroke. Patients with valve disease are at higher risk of thrombus formation before and after surgery. The aim of this study was to investigate the role of 4-dimensional cardiac computed tomography (4DCT) to predict the risk of thrombus formation. Methods: Between March 2010 to March 2015, total of 62 patients (mean 60±15 years old, male: 53.2%) who underwent 4DCT and TEE for cardiac valve evaluation before surgery were retrospectively included in the current study. Fractional area change in TEE view and emptying velocity at left atrial appendage in TEE view (Ve TEE ) were measured. Ejection fraction (EF) of left atrial appendage in computed tomography (EF CT ) was calculated by 4DCT with full volume analysis. The best cut-off value of EF CT predicting presence of spontaneous echo contrast (SEC) or thrombus was evaluated, and correlation between the parameters were also estimated. Results: SEC or thrombus was observed in 45.2%. EF CT and Ve TEE were significantly correlated (r=0.452, p<0.001). However, fractional area change measured by TEE showed no correlation with Ve TEE (r=0.085, p=0.512). EF CT <37.5% best predicted SEC or thrombus in the patients with valve disease who underwent 4DCT and TEE (area under the curve, 0.654; p=0.038). Conclusions: In the patients who underwent 4DCT for cardiac valve evaluation before surgery, EF CT by volume analysis might have additional role to evaluate LAA function and estimate the risk of thrombus.

Original languageEnglish
Pages (from-to)173-180
Number of pages8
JournalKorean Circulation Journal
Volume49
Issue number2
DOIs
Publication statusPublished - 2019 Feb

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Four-Dimensional Computed Tomography
Atrial Appendage
Heart Valve Diseases
Transesophageal Echocardiography
Thrombosis
Tomography
Heart Valves
Left Atrial Function
Cone-Beam Computed Tomography
Area Under Curve
Stroke

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{5f229119adbf47cda15b3b1975117212,
title = "Benefit of four-dimensional computed tomography derived ejection fraction of the left atrial appendage to predict thromboembolic risk in the patients with valvular heart disease",
abstract = "Background and Objectives: Decreased left atrial appendage (LAA) emptying velocity in transesophageal echocardiography (TEE) is related with higher incidence of thrombus and increased risk of stroke. Patients with valve disease are at higher risk of thrombus formation before and after surgery. The aim of this study was to investigate the role of 4-dimensional cardiac computed tomography (4DCT) to predict the risk of thrombus formation. Methods: Between March 2010 to March 2015, total of 62 patients (mean 60±15 years old, male: 53.2{\%}) who underwent 4DCT and TEE for cardiac valve evaluation before surgery were retrospectively included in the current study. Fractional area change in TEE view and emptying velocity at left atrial appendage in TEE view (Ve TEE ) were measured. Ejection fraction (EF) of left atrial appendage in computed tomography (EF CT ) was calculated by 4DCT with full volume analysis. The best cut-off value of EF CT predicting presence of spontaneous echo contrast (SEC) or thrombus was evaluated, and correlation between the parameters were also estimated. Results: SEC or thrombus was observed in 45.2{\%}. EF CT and Ve TEE were significantly correlated (r=0.452, p<0.001). However, fractional area change measured by TEE showed no correlation with Ve TEE (r=0.085, p=0.512). EF CT <37.5{\%} best predicted SEC or thrombus in the patients with valve disease who underwent 4DCT and TEE (area under the curve, 0.654; p=0.038). Conclusions: In the patients who underwent 4DCT for cardiac valve evaluation before surgery, EF CT by volume analysis might have additional role to evaluate LAA function and estimate the risk of thrombus.",
author = "Kim, {In Cheol} and Chang, {Hyuk Jae} and Cho, {In Jeong} and Shim, {Chi Young} and Hong, {Geu Ru} and {Hoe Heo}, Ji and {Suk Nam}, Hyo and Kim, {Young Jin} and Choi, {Byoung Wook} and Namsik Chung",
year = "2019",
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doi = "10.4070/kcj.2018.0152",
language = "English",
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pages = "173--180",
journal = "Korean Circulation Journal",
issn = "1738-5520",
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}

Benefit of four-dimensional computed tomography derived ejection fraction of the left atrial appendage to predict thromboembolic risk in the patients with valvular heart disease. / Kim, In Cheol; Chang, Hyuk Jae; Cho, In Jeong; Shim, Chi Young; Hong, Geu Ru; Hoe Heo, Ji; Suk Nam, Hyo; Kim, Young Jin; Choi, Byoung Wook; Chung, Namsik.

In: Korean Circulation Journal, Vol. 49, No. 2, 02.2019, p. 173-180.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Benefit of four-dimensional computed tomography derived ejection fraction of the left atrial appendage to predict thromboembolic risk in the patients with valvular heart disease

AU - Kim, In Cheol

AU - Chang, Hyuk Jae

AU - Cho, In Jeong

AU - Shim, Chi Young

AU - Hong, Geu Ru

AU - Hoe Heo, Ji

AU - Suk Nam, Hyo

AU - Kim, Young Jin

AU - Choi, Byoung Wook

AU - Chung, Namsik

PY - 2019/2

Y1 - 2019/2

N2 - Background and Objectives: Decreased left atrial appendage (LAA) emptying velocity in transesophageal echocardiography (TEE) is related with higher incidence of thrombus and increased risk of stroke. Patients with valve disease are at higher risk of thrombus formation before and after surgery. The aim of this study was to investigate the role of 4-dimensional cardiac computed tomography (4DCT) to predict the risk of thrombus formation. Methods: Between March 2010 to March 2015, total of 62 patients (mean 60±15 years old, male: 53.2%) who underwent 4DCT and TEE for cardiac valve evaluation before surgery were retrospectively included in the current study. Fractional area change in TEE view and emptying velocity at left atrial appendage in TEE view (Ve TEE ) were measured. Ejection fraction (EF) of left atrial appendage in computed tomography (EF CT ) was calculated by 4DCT with full volume analysis. The best cut-off value of EF CT predicting presence of spontaneous echo contrast (SEC) or thrombus was evaluated, and correlation between the parameters were also estimated. Results: SEC or thrombus was observed in 45.2%. EF CT and Ve TEE were significantly correlated (r=0.452, p<0.001). However, fractional area change measured by TEE showed no correlation with Ve TEE (r=0.085, p=0.512). EF CT <37.5% best predicted SEC or thrombus in the patients with valve disease who underwent 4DCT and TEE (area under the curve, 0.654; p=0.038). Conclusions: In the patients who underwent 4DCT for cardiac valve evaluation before surgery, EF CT by volume analysis might have additional role to evaluate LAA function and estimate the risk of thrombus.

AB - Background and Objectives: Decreased left atrial appendage (LAA) emptying velocity in transesophageal echocardiography (TEE) is related with higher incidence of thrombus and increased risk of stroke. Patients with valve disease are at higher risk of thrombus formation before and after surgery. The aim of this study was to investigate the role of 4-dimensional cardiac computed tomography (4DCT) to predict the risk of thrombus formation. Methods: Between March 2010 to March 2015, total of 62 patients (mean 60±15 years old, male: 53.2%) who underwent 4DCT and TEE for cardiac valve evaluation before surgery were retrospectively included in the current study. Fractional area change in TEE view and emptying velocity at left atrial appendage in TEE view (Ve TEE ) were measured. Ejection fraction (EF) of left atrial appendage in computed tomography (EF CT ) was calculated by 4DCT with full volume analysis. The best cut-off value of EF CT predicting presence of spontaneous echo contrast (SEC) or thrombus was evaluated, and correlation between the parameters were also estimated. Results: SEC or thrombus was observed in 45.2%. EF CT and Ve TEE were significantly correlated (r=0.452, p<0.001). However, fractional area change measured by TEE showed no correlation with Ve TEE (r=0.085, p=0.512). EF CT <37.5% best predicted SEC or thrombus in the patients with valve disease who underwent 4DCT and TEE (area under the curve, 0.654; p=0.038). Conclusions: In the patients who underwent 4DCT for cardiac valve evaluation before surgery, EF CT by volume analysis might have additional role to evaluate LAA function and estimate the risk of thrombus.

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DO - 10.4070/kcj.2018.0152

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