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Morphological and functional assessment of the left atrial appendage in daily practice: a comprehensive approach
1Department of Cardiology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. ashrafanwar2000@hotmail.com.
Insights
Cardioembolic stroke from atrial fibrillation (AF) poses a high mortality risk. Echocardiography is crucial for assessing left atrial appendage (LAA) thrombi, vital for guiding interventions.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Cardioembolic stroke is a severe complication of atrial fibrillation (AF).
- Left atrial appendage (LAA) thrombi are frequently found in AF patients, posing significant risks.
- Accurate thrombi detection in the LAA is critical for patient management.
Purpose of the Study:
- To review the anatomical, physiological, and pathological aspects of the LAA.
- To assess various echocardiographic modalities for LAA thrombi evaluation.
- To provide practical guidance for improving diagnostic accuracy in LAA thrombi assessment.
Main Methods:
- Review of existing literature on LAA anatomy, physiology, and pathology.
- Assessment of echocardiographic techniques for LAA thrombi identification.
- Compilation of practical tips for image acquisition and interpretation.
Main Results:
- LAA thrombi are prevalent in AF, with varying rates in valvular and nonvalvular AF.
- Echocardiography is a key imaging modality for LAA assessment.
- Specific imaging parameters and information are crucial for different clinical scenarios.
Conclusions:
- Accurate assessment of LAA morphology and function using echocardiography is essential.
- Improved diagnostic accuracy in LAA thrombi detection can guide interventional procedures.
- This review offers practical insights for clinicians managing AF patients at risk of stroke.
Abstract:
Cardioembolic stroke is the most serious and life-threatening complication of atrial fibrillation (AF), with an associated mortality up to 30% at 12 months. Approximately 47% of thrombi in valvular AF and 91% of thrombi in nonvalvular AF are localized in the left atrial appendage (LAA). Therefore, identification or exclusion of LAA thrombi is critical in many clinical situations. It is essential to assess LAA morphology and function using imaging modalities (particularly echocardiography) before, during, and after interventional procedures such as AF ablation and LAA occlusion. This review article describes the anatomical, physiological, and pathological background of the LAA, followed by an assessment of different echocardiographic modalities. Many practical points are included to improve the diagnostic accuracy and to minimize errors during image acquisition and interpretation. In each clinical scenario where LAA is the crucial target, specific and essential information and parameters are collected.
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