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Severity of Pseudofilling Defect in the Left Atrial Appendage on Cardiac Computed Tomography Is a Simple Predictor of the Degree of Left Atrial Emptying Dysfunction in Patients With Chronic Atrial Fibrillation

Ishiyama, Mitsutomi MD; Akaike, Gensuke MD; Matsusako, Masaki MD; Ueda, Takuya MD, PhD; Makidono, Akari MD; Ohde, Sachiko EdM; Mizuno, Atsushi MD; Nishihara, Shuzo MD; Saida, Yukihisa MD, PhD

Journal of Computer Assisted Tomography: July/August 2012 - Volume 36 - Issue 4 - p 450–454
doi: 10.1097/RCT.0b013e31825b88d2
Cardiovascular and Thoracic Imaging

Objectives The purpose of our study was to investigate the clinical relevance of a pseudofilling defect in the left atrial appendage (LAA) detected on coronary computed tomography (CT) angiography (CCTA) as an indicator of impaired left atrial (LA) volumetric function in patients with chronic atrial fibrillation (CAF).

Methods Forty-two patients with CAF underwent CCTA. Quantitative and visual measurements of contrast enhancement of the LAA were performed, and they were correlated with results of CT volumetric functional analysis of the LA. Four volumetric parameters representing LA function were measured: maximum (LAVmax) and minimum volumes of the LA (LAVmin) through the entire cardiac cycle; LA emptying volume (LAEV); and LA emptying fraction (LAEF). All volumetric parameters were standardized by body surface area to adjust for variation in LA size among patients. For quantitative measurement, the CT attenuation was measured at the LAA and the LA to calculate an LAA/LA attenuation ratio. For visual measurement, contrast enhancement of the LAA was categorized into 3 groups; no filling defect, mild-to-moderate pseudofilling defect, and severe pseudofilling defect group. The Spearman correlation coefficient and the Kruskal-Wallis test were used for statistical analysis.

Results The LAA/LA ratio showed a strong positive correlation with LAEV (r = 0.52; P < 0.001) and LAEF (r = 0.69; P < 0.001). The LAEV in the no pseudofilling defect group and the mild-to-moderate and severe pseudofilling defect groups were 16.1 ± 8.4, 10.8 ± 3.1, and 6.7 ± 4.9 mL/m2, respectively (P < 0.001). The LAEF in each group were 24.2 ± 13.8%, 12.0 ± 3.4%, and 6.9 ± 3.1%, respectively (P < 0.001).

Conclusions The severity of pseudofilling defect in the LAA on CCTA could predict the degree of LA emptying dysfunction in patients with CAF.

From the *Department of Radiology, St. Luke’s International Hospital; †Center for Clinical Epidemiology, St. Luke’s Life Science Institute; and ‡Department of Cardiology, St. Luke’s International Hospital, Tokyo, Japan.

Received for publication February 17, 2012; accepted April 6, 2012.

Reprints: Mitsutomi Ishiyama, MD, Department of Radiology, St. Luke’s International Hospital, Akashi-cho 9-1, Chuo-ku, Tokyo, 104-8560 Japan (e-mail:

The authors report no conflicts of interest.

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.