Multimodality approach for endovascular left atrial appendage closure: head-to-head comparison among 2D and 3D echocardiography, angiography and computer tomography
Purpose. Percutaneous left atrial appendage closure (LAAC) requires accurate pre- and intraprocedural measurements and multimodality imaging is an essential tool for guiding the procedure. Two-dimensional (2D TEE) and three-dimensional (3D TEE) transesophageal echocardiography, cardiac computed tomography (CCT) and conventional cardiac angiography (CCA) are commonly used to evaluate left atrial appendage (LAA) size. However, standardized approaches in measurement methods across different imaging modalities are lacking. The aims of the study were to evaluate the LAA dimension and morphology in patients undergoing LAAC and compare data obtained by different imaging modalities: 2D and 3D TEE, CCT and CCA. Methods. A total of 188 patients (mean age 70 8 years, 94 males) were examined by different techniques (161 2D TEE, 103 3D TEE, 98 CCT, 188 CCA). Patients were submitted to preoperatory CCT and intraoperatory 2D and 3D TEE and CCA. Results. Statistical analysis showed a significant correlation for all measurements obtained by different modalities. In particular, we noticed that 3D TEE and CCT measurements were highly correlated with an excellent agreement for the landing zone (LZ) dimensions (r=0.87 for LZ diameter and r=0.91 for LAA depth). Conclusions. Head-to-head comparison among different imaging techniques (2D and 3D TEE, CCT and CCA) shows a good correlation of LZ diameter measured with all imaging modalities, which is a parameter of paramount importance for the choice of device size. In particular, LZ diameter and area by 3D TEE had the best correlation with CCT.