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Updated: Jul 6, 2025
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Cardiac computed tomography angiography for assessment of endothelial insufficiency of left atrial appendage
Zhiyong Duan1, Genling Shi1, Bin Wang2
1Departments of Cardiology of Zhongshan Hospital Wusong Branch, Fudan University, Shanghai, China.
Insights
Cardiac computed tomography angiography (CCTA) can effectively diagnose endothelial insufficiency (EIS) in left atrial appendage (LAA) occluders, showing EIS patients achieve better endothelialization than those with peri-device leakage (PDL).
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
Background:
- Left atrial appendage (LAA) occluders are used to prevent stroke in nonvalvular atrial fibrillation.
- Assessing the endothelialization of LAA occluders is crucial for long-term device efficacy.
- Endothelial insufficiency (EIS) and peri-device leakage (PDL) are potential complications after LAA occlusion.
Purpose of the Study:
- To evaluate the diagnostic value of cardiac computed tomography angiography (CCTA) for identifying EIS of LAA disc-like occluders.
- To compare the endothelialization rates between patients with EIS and PDL.
Main Methods:
- Retrospective analysis of 59 patients with nonvalvular atrial fibrillation who received LAmbre LAA occluders.
- Postoperative CCTA at 3 months for Hounsfield unit (HU) measurement and 3D model construction to differentiate PDL from EIS.
- Transesophageal echocardiography (TEE) used for concordance verification.
- Patients categorized into PDL, total endothelialization, and EIS groups.
- 6-month follow-up to assess endothelialization status.
Main Results:
- Successful implantation in all 59 patients.
- 35 patients showed contrast agent entering the LAA at 3-month CCTA.
- 19 patients diagnosed with PDL and 16 with EIS based on CCTA findings.
- TEE confirmed CCTA results.
- At 6 months, 14/19 EIS patients achieved total endothelialization versus 5/19 PDL patients.
Conclusions:
- CCTA is a reliable tool for assessing LAA occluder endothelialization status, potentially replacing TEE.
- Patients with EIS demonstrate a higher likelihood of achieving complete endothelialization compared to those with PDL.
Introduction:
This study was performed to explore the diagnostic value of cardiac computed tomography angiography (CCTA) for endothelial insufficiency (EIS) of a left atrial appendage (LAA) disc-like occluder.
Methods:
Fifty-nine patients with nonvalvular atrial fibrillation who underwent placement of an LAA disc-like occluder (LAmbre; Lifetech Scientific) in our hospital were retrospectively analyzed. Patients who were found to have contrast agent entering the LAA at the 3-month postoperative CCTA examination underwent Hounsfield unit (HU) measurement of the LAA and construction of a three-dimensional (3D) model of the device for preliminary discernment between peri-device leakage (PDL) and EIS. These patients were then further examined by transesophageal echocardiography (TEE) to check for concordance with the computed tomography (CT) findings. According to the CT and TEE results, all patients were divided into the PDL group, total endothelialization group, and EIS group. The endothelial conditions and other implantation-related results were also tracked at the 6-month follow-up.
Results:
All 59 patients underwent successful implantation of the LAmbre LAA closure device with no severe adverse events during the procedure. Thirty-five patients were found to have contrast agent entering the LAA at the 3-month postoperative CCTA follow-up. Based on the CT HU measurement and the 3D construction analysis results, these 35 patients were divided into the PDL group (19 patients) and the EIS group (16 patients). In the PDL group, the contrast agent infiltrated from the shoulder along the periphery of the occluder on two-dimensional (2D) CT images, and the 3D model showed a gap between the LAA and the device cover. However, the CCTA images of the other 16 patients in the EIS group showed that the contrast agent in the occluder on the 2D CTA images and 3D construction model confirmed the absence of a gap between the LAA and the device cover. TEE confirmed all of the CT results. The 6-month follow-up results showed that 14 of 19 patients in the EIS group achieved total endothelialization, whereas this number in the PDL group was only five of 19 patients.
Conclusion:
CCTA can replace TEE for examination of the endothelialization status, and patients with EIS have a higher chance of endothelialization than patients with PDL.
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