Evaluation of Left Atrial Degeneration for the Prediction of Atrial FibrillationUsefulness of Integrated Backscatter Transesophageal Echocardiography
Tomoki Kubota, MD,
Masanori Kawasaki, MD, PhD*,
Nobuhiro Takasugi, MD,
Urara Takeyama, MD, PhD,
Yoshiyuki Ishihara, MD,
Munenori Okubo, MD, PhD,
Takahiko Yamaki, MD,
Shinsuke Ojio, MD, PhD,
Takuma Aoyama, MD, PhD,
Masazumi Arai, MD, PhD,
Kazuhiko Nishigaki, MD, PhD,
Genzou Takemura, MD, PhD,
Hisayoshi Fujiwara, MD, PhD,
Shinya Minatoguchi, MD, PhD
Regeneration and Advanced Medical Science, Gifu University Graduate School of Medicine, Gifu, Japan
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Figure 1 Measurement Site of LA
(A) Cross-sectional image of the left atrium (LA) depicted by transesophageal echocardiography (TEE). Images of the LA were depicted, and integrated backscatter (IBS) values of entire lateral, septal, and anterior walls of the LA were measured at 5-mm intervals. (B) Schematic image of the analyzed site (square). Lateral, anterior, and septal walls of the LA were analyzed. LAA = left atrial appendage; LV = left ventricle.
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Figure 2 Representative Images in the Pathological Study
(A) Representative histological image of the LA. (B) Histological image in which interstitial area was selected (yellow) by a multipurpose image processor (LUZEX F, Nireco Co., Tokyo, Japan). (C) Representative images of low-grade degeneration of the LA (relative interstitial area: 32%). (D) Representative images of high-grade degeneration of the LA (relative interstitial area: 46%).
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Figure 3 Correlation of Relative Interstitial Area and cIBS Values
As the relative interstitial area of the left atrial (LA) wall became larger, the corrected integrated backscatter (cIBS) values of the LA wall became greater. There was a weak correlation between the relative interstitial area and the average of cIBS values in the LA wall. Open circles = patients without atrial fibrillation; orange circles = patients with atrial fibrillation.
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Figure 4 Receiver-Operating Characteristic Curves Analysis for Predicting Atrial Fibrillation
(Left) Pathological study. (Right) Clinical study. The optimum cutoffs for discriminating atrial fibrillation were obtained from the receiver operating characteristic curve analysis. The optimal cutoffs were 20 dB in the clinical study and 52 dB in the pathological study. AUC = area under the receiver operating characteristic curve.
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Figure 5 Ultrasound Parameters of Chronic AF, PAF, and NSR Groups
Average corrected integrated backscatter (IBS) values of total pixels in color-coded maps in the atrial fibrillation (AF) group and the paroxysmal atrial fibrillation (PAF) group were significantly greater than those in the normal sinus rhythm (NSR) group, whereas there were no significant differences in the left atrial (LA) diameter, the LA volume, and left atrial appendage (LAA) peak velocity between the PAF group and the NSR group. *p < 0.05;  p < 0.01.
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Figure 6 Three-Dimensional IBS Color-Coded Maps of the LA
The area of a high degree of degeneration was indicated by red and yellow colors, and no or a low degree of degeneration was indicated by green and blue colors. By looking at these images, we were easily able to identify the location of areas of degeneration in the LA wall. Abbreviations as in Figure 5.
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