Evaluation of left atrial appendage thrombi using three dimensional transesophageal echocardiography and pulse wave doppler (about 72 cases) – Continuum

Introduction: Visual assessment alone does not definitively rule out left atrial appendage thrombi (LAA) in 2D transesophageal echocardiography (TEE). Hence, seeking other direct (3D three-dimensional) and indirect modalities (pulse wave Doppler) is of interest.Materials and Methods: LAA morphotype, and parameters of morphological remodeling were evaluated: enlargement of LAA by measuring its long axis maximum area (LAA-MA). Along with functional: LAA contraction by measuring the maximum emptying velocity (MEV) and investigating the MEV/LAA-MA ratio. Recruiting 72 patients from Dec 14^th 2020 until Oct 7^th 2021, at A2 Cardiology department, Mustapha Pacha University Hospital in Algiers. The patients had TEE (2D/3D) for various indications (majorly valvular diseases). The evaluation is mainly focused on the number of patients with LAA thrombi, LAA morphotype, LAA-MA dilation (threshold > 6cm²), decrease in MEV (threshold <25cm/s), and measuring the velocity/ area ratio (threshold <1.7). Secondarily, we appreciated the influence of gender and heart rhythm in LAA thrombotic formation. Results: An incidence of LAA thrombi was estimated at 17%, Windsock was the most frequent morphotype (48.6%), and Cauliflower type seems to be the most thrombogenic (44.4%). LAA dilation had poor diagnostic accuracy. The decrease in MEV was the most sensitive (Se: 100%), and the velocity/area ratio was the most specific criterion (Sp: 98.3%). Secondarily, female gender (Female/Male ratio: 5.5), and atrial fibrillation (AF/Sinus rhythm ratio: 7.8) can be considered as factors associated with the genesis of LAA thrombi. Conclusions: the evaluation of LAA thrombosis by 3D TEE coupled with pulse wave Doppler using cut-off values of MEV < 25cm/s and an MEV/LAA-MA ratio <1.7, seems to be a reliable diagnostic approach to exclude LAA thrombi.