Patient characteristics. The mean age of all patients was 65 ± 15 years, and 206 patients were male. Patient characteristics and transthoracic echocardiographic parameters are shown in Table 1. One hundred five patients had non-AF, 86 had paroxysmal AF, 87 had persistent AF, and 62 had long-standing persistent AF. Patients with long-standing persistent AF had larger LA dilatation and LA volume index, higher E/e’ ratio, and moderate-to-severe MR and TR more frequently. CHA2DS2-VASc and HAS-BLED scores were higher in patients with long-standing persistent AF.
Table 1
Patient characteristics and transthoracic echocardiographic parameters.
|
Non-AF
(n = 105)
|
Paroxysmal AF
(n = 86)
|
Persistent AF
(n = 87)
|
Long-standing persistent AF
(n = 62)
|
P
|
Age (years)
|
57 ± 17
|
69 ± 11
|
68 ± 12
|
70 ± 11
|
< 0.01
|
Male
|
56 (53%)
|
50 (58%)
|
56 (64%)
|
44 (71%)
|
0.12
|
Body surface area (m2)
|
1.6 ± 0.2
|
1.6 ± 0.2
|
1.7 ± 0.2
|
1.6 ± 0.2
|
0.17
|
CHA2D2-VASc score
|
1.7 ± 1.7
|
2.8 ± 1.5
|
3.3 ± 1.8
|
3.8 ± 2.0
|
< 0.01
|
HAS-BLED score
|
0.6 ± 0.8
|
1.4 ± 1.1
|
1.2 ± 0.9
|
1.7 ± 1.3
|
< 0.01
|
LV end-diastolic diameter (mm)
|
45 ± 7
|
47 ± 8
|
47 ± 7
|
47 ± 6
|
0.12
|
LV end-systolic diameter (mm)
|
29 ± 6
|
32 ± 8
|
33 ± 8
|
33 ± 7
|
< 0.01
|
LV ejection fraction (%)
|
64 ± 7
|
60 ± 12
|
56 ± 13
|
56 ± 12
|
< 0.01
|
LA diameter (mm)
|
37 ± 6
|
40 ± 6
|
45 ± 5
|
46 ± 7
|
< 0.01
|
LA volume index (ml/m2)
|
38 ± 14
|
41 ± 10
|
52 ± 16
|
60 ± 18
|
< 0.01
|
E (cm/s)
|
67 ± 22
|
68 ± 20
|
83 ± 25
|
92 ± 35
|
< 0.01
|
e’ (cm/s)
|
7 ± 3
|
5 ± 2
|
7 ± 2
|
6 ± 2
|
< 0.01
|
E/e’ ratio
|
11 ± 7
|
14 ± 6
|
14 ± 7
|
17 ± 9
|
< 0.01
|
Moderate-to-severe MR
|
10 (10%)
|
7 (8%)
|
23 (26%)
|
19 (31%)
|
< 0.01
|
Moderate-to-severe TR
|
13 (12%)
|
10 (12%)
|
20 (23%)
|
17 (27%)
|
0.02
|
TR pressure gradient (mm Hg)
|
27 ± 16
|
25 ± 7
|
26 ± 9
|
29 ± 10
|
0.22
|
Data are presented as mean ± standard deviation or number (%) of patients.
AF atrial fibrillation, CHA2D2-VASc congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65-74 years, sex category, E early diastolic mitral valve flow velocity, e’ early diastolic septal mitral annular velocity, HAS-BLED hypertension, abnormal renal or liver function, stroke, bleeding, labile international normalized ratio, elderly, drugs or alcohol, LA left atrial, LV left ventricular, MR mitral regurgitation, TR tricuspid regurgitation.
Left atrial appendage morphology. LAA ostial diameter and depth according to the types of AF are shown in Table 2. In TEE views of an angle of 0°, 45°, 90°, and 135°, LAA ostial diameter and depth were larger in patients with long-standing persistent AF. The maximum LAA ostial diameter measured in any TEE views of 0°, 45°, 90°, or 135° was 19 ± 4 mm in patients with non-AF, 21 ± 4 mm in patients with paroxysmal AF, 23 ± 5 mm in patients with persistent AF, and 26 ± 5 mm in patients with long-standing persistent AF. LAA ostial diameter was increased by 2 or 3 mm with the progression of AF. Patients with long-standing persistent AF had greater LAA lobes and lower LAA flow velocity. LAA shape was not different in the types of AF.
Table 2
Left atrial appendage morphology according to the types of atrial fibrillation.
|
Non-AF
(n = 105)
|
Paroxysmal AF
(n = 86)
|
Persistent AF
(n = 87)
|
Long-standing persistent AF
(n = 62)
|
P
|
LAA ostial diameter (mm)
|
|
|
|
|
|
0°
|
16 ± 5
|
18 ± 4
|
20 ± 5
|
22 ± 5
|
< 0.01
|
45°
|
15 ± 4
|
17 ± 4
|
19 ± 4
|
21 ± 4
|
< 0.01
|
90°
|
15 ± 4
|
17 ± 4
|
19 ± 4
|
22 ± 4
|
< 0.01
|
135°
|
18 ± 4
|
20 ± 5
|
22 ± 5
|
25 ± 5
|
< 0.01
|
Maximum
|
19 ± 4
|
21 ± 4
|
23 ± 5
|
26 ± 5
|
< 0.01
|
LAA depth (mm)
|
|
|
|
|
|
0°
|
24 ± 5
|
28 ± 6
|
30 ± 7
|
30 ± 7
|
< 0.01
|
45°
|
25 ± 5
|
28 ± 6
|
29 ± 6
|
31 ± 6
|
< 0.01
|
90°
|
24 ± 6
|
27 ± 6
|
29 ± 6
|
31 ± 7
|
< 0.01
|
135°
|
23 ± 5
|
27 ± 6
|
29 ± 7
|
31 ± 7
|
< 0.01
|
Maximum
|
27 ± 8
|
30 ± 6
|
33 ± 6
|
34 ± 7
|
< 0.01
|
LAA shape
|
|
|
|
|
|
Chicken wing
|
27 (26%)
|
21 (24%)
|
15 (17%)
|
10 (16%)
|
0.31
|
Non-chicken wing
|
78 (74%)
|
65 (76%)
|
72 (83%)
|
52 (84%)
|
|
LAA lobes
|
1.2 ± 0.5
|
1.6 ± 0.7
|
1.8 ± 0.6
|
1.9 ± 0.8
|
< 0.01
|
LAA flow velocity (m/s)
|
58 ± 20
|
50 ± 19
|
32 ± 19
|
26 ± 15
|
< 0.01
|
Data are presented as mean ± standard deviation or number (%) of patients.
AF atrial fibrillation, LAA left atrial appendage.
Correlation with left atrial appendage size. Among patients with paroxysmal AF, persistent AF, and long-standing persistent AF, LAA ostial diameter (R = 0.37, P < 0.01) and LAA depth (R = 0.44, P < 0.01) were correlated with LA volume index. LAA ostial diameter was correlated with the duration of continuous AF (R = 0.30, P < 0.01) (Fig. 2), but not with age or the period from the onset of AF. The correlations of LAA ostial diameter with CHA2D2-VASc or HAS-BLED scores were not observed.
Reproducibility. There was good agreement in the measurements of LAA ostial diameter in the interobserver assessment (R = 0.92, P < 0.01) and intraobserver assessment (R = 0.93, P < 0.01). The interobserver and intraobserver variabilities in LAA ostial diameter were 4.9% and 4.3%, respectively.