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Left atrial appendage spontaneous echo contrast in patients with atrial arrhythmias using integrated backscatter and transesophageal echocardiography

      Integrated backscatter (IBS) imaging technology has been used in a wide range of clinical conditions to help characterize tissue abnormalities including myocardial diseases
      • Takiuchi S.
      • Ito H.
      • Iwakura K.
      • Taniyama Y.
      • Nishikawa N.
      • Masuyama T.
      • Hori M.
      • Higashino Y.
      • Fujii K.
      • Minamino T.
      Ultrasonic tissue characterization predicts myocardial viability in early stage of reperfused acute myocardial infarction.
      ,
      • Angermann C.E.
      • Nassau K.
      • Stempfle H.U.
      • Kruger T.M.
      • Drewello R.
      • Junge R.
      • Uberfuhr P.
      • Weiss M.
      • Theisen K.
      Recognition of acute cardiac allograft rejection from serial integrated backscatter analyses in human orthotopic heart transplant recipients. Comparison with conventional echocardiography.
      ,
      • Vitale D.F.
      • Bonow R.O.
      • Gerundo G.
      • Pelaggi N.
      • Lauria G.
      • Leosco D.
      • Coltorti F.
      • Bordini C.
      • Rengo C.
      • Rengo F.
      Alterations in ultrasonic backscatter during exercise-induced myocardial ischemia in humans.
      ,
      • Naito J.
      • Masuyama T.
      • Tanouchi J.
      • Mano T.
      • Kondo H.
      • Yamamoto K.
      • Nagano R.
      • Hori M.
      • Inoue M.
      • Kamada T.
      Analysis of transmural trend of myocardial integrated ultrasound backscatter for differentiation of hypertrophic cardiomyopathy and ventricular hypertrophy due to hypertension.
      ,
      • Stewart W.J.
      • Rodkey S.M.
      • Gunawardena S.
      • White R.D.
      • Luvisi B.
      • Klein A.L.
      • Salcedo E.
      Left ventricular volume calculation with integrated backscatter from echocardiography.
      and thrombi.
      • Recchia D.
      • Wickline S.A.
      Ultrasonic tissue characterization of blood during stasis and thrombosis with a real-time linear-array backscatter imaging system.
      ,
      • Yuan Y.W.
      • Shung K.K.
      Ultrasonic backscatter from flowing whole blood. I Dependence on shear rate and hematocrit.
      ,
      • Yuan Y.W.
      • Shung K.K.
      Ultrasonic backscatter from flowing whole blood. II Dependence on frequency and fibrinogen concentration.
      Previously, we and others
      • Klein A.L.
      • Murray R.D.
      • Black I.W.
      • Chandra S.
      • Grimm R.A.
      • Da D.S.
      • Leung D.Y.
      • Miller D.
      • Morehead A.J.
      • Vaughn S.E.
      • Thomas J.D.
      Integrated backscatter for quantification of left atrial spontaneous echo contrast.
      • Ito T.
      • Suwa M.
      • Nakamura T.
      • Miyazaki S.
      • Kawamura K.
      Influence of warfarin therapy on left atrial spontaneous echo contrast in nonvalvular atrial fibrillation.
      • Wang A.
      • Harrison J.K.
      • Bashore T.M.
      Correlation between quantitative left atrial spontaneous echocardiographic contrast and intact fibrinogen levels in mitral stenosis.
      reported quantitative assessment of left atrial (LA) cavity spontaneous echo contrast (SEC) using IBS. However, it is not known whether LA appendage (LAA) SEC can also be measured quantitatively, and if there exists a relation between LAA Doppler flow velocities and a quantitative measure of SEC. Use of IBS in assessing the severity of SEC may reduce errors resulting from human subjectivity. SEC assessment is highly influenced by the experience level of the operator in the use of transesophageal echocardiography. Inexperienced observers may either under- or overestimate the presence and severity of SEC, leading to a possible change in the clinical management of the patient. A quantitative IBS evaluation may provide an additional objective tool, if not a replacement, for qualitative assessment of SEC, especially in situations in which an observer may not be comfortable in visually grading the presence or severity of SEC. The present study assessed LAA SEC in patients with atrial arrhythmia using IBS and its correlation with qualitative grades of SEC and clinical and echocardiographic predictors of thromboembolism.
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