Table 1

Different Echocardiography Modalities Evaluated When Using Echocardiography to Assess the LAA

Echocardiographic ModalityParameters EvaluatedComments
2D and 3D echocardiographyVisual assessment for the presence of thrombi or other pathologies within the LAA as noted in Table 2.If there is inadequate visualization or artifacts, ultrasound contrast agents can enhance visualization.
ICE can serve as a complementary method for evaluation.
Spectral DopplerEvaluation of flow in the LAA using pulsed-wave Doppler:
Velocities >40 cm/s are suggestive of adequate flow within the appendage and a low risk for thrombus formation.
Color Doppler to a low Nyquist limit can aid in visualization of flow within the LAA.
Easily performed, highly reproducible, and carries relevant clinical implications.
When Doppler signal is limited, microbubble contrast agent enhances visualization of contractility indices.
Tissue Doppler and strain imagingLimited studies.
E/e' and e' velocity were found to be independently associated with an LAA thrombus in patients with nonvalvular AF.
Compromised LAA contractile fraction, measured by speckle-tracking, strain-based methods, was an independent determinant of LAA thrombus.
Not routinely used.

AF = atrial fibrillation; ICE = intracardiac echocardiography; LAA = left atrial appendage; 2D = 2-dimensional; 3D = 3-dimensional.