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. 2020 Jan;43(1):71-77.
doi: 10.1002/clc.23292. Epub 2019 Nov 22.

Difference in Left Atrial Appendage Remodeling Between Diabetic and Nondiabetic Patients With Atrial Fibrillation

Free PMC article

Difference in Left Atrial Appendage Remodeling Between Diabetic and Nondiabetic Patients With Atrial Fibrillation

Chaim Yosefy et al. Clin Cardiol. .
Free PMC article


Background: Diabetes mellitus (DM) is a common and increasingly prevalent condition in patients with atrial fibrillation (AFib). The left atrium appendage (LAA), a small outpouch from the LA, is the most common location for thrombus formation in patients with AFib.

Hypothesis: In this study, we examined LAA remodeling differences between diabetic and nondiabetic patients with AFib.

Methods: This retrospective study analyzed data from 242 subjects subdivided into two subgroups of 122 with DM (diabetic group) and 120 without DM (nondiabetic group). The study group underwent real-time 3-dimensional transesophageal echocardiography (RT3DTEE) for AFib ablation, cardioversion, or LAA device closure. The LAA dimensions were measured using the "Yosefy rotational 3DTEE method."

Results: The RT3DTEE analysis revealed that diabetic patients display larger LAA diameters, D1-lengh (2.09 ± 0.50 vs 1.88 ± 0.54 cm, P = .003), D2-width (1.70 ± 0.48 vs 1.55 ± 0.55 cm, P = .024), D3-depth (2.21 ± 0.75 vs 1.99 ± 0.65 cm, P = .017), larger orifice areas (2.8 ± 1.35 and 2.3 ± 1.49 cm2 , P = .004), and diminished orifice flow velocity (37.3 ± 17.6 and 43.7 ± 19.5 cm/sec, P = .008).

Conclusions: Adverse LAA remodeling in DM patients with AFib is characterized by significantly LAA orifice enlargement and reduced orifice flow velocity. Analysis of LAA geometry and hemodynamics may have clinical implications in thrombotic risk assessment and treatment of DM patients with AFib.

Keywords: atrial fibrillation; diabetes mellitus; left atrial appendage; left atrium; real-time 3-dimensional transesophageal echocardiography; stroke.

Conflict of interest statement

The authors declare that there is no conflict of interest.


Figure 1
Figure 1
3D TEE analysis of the LAA maximal parameters measurement, at “one stop shop” point, using 360° “Yosefy rotational 3DTEE method”. A, After exclusion of thrombi and verifying the lobe structure with the rotation, measurement of depth (D3) can be made directly at this point. B, The maximal and minimal LAA diameters (D1‐length and D2‐width, respectively) at the level of the Cx artery can be measured more accurately on the orthogonal view (C). D, 3D imaging of “Yosefy Rotational 3DTEE method”. CX, circumflex; LA, left atrium; LAA, left atrium appendage
Figure 2
Figure 2
Difference in left atrium appendage characteristic in the diabetic group and the nondiabetic group. A, Depth, length, and width. B, LAA orifice area. C, LAA flow velocity. D, Spontaneous echo contrast distribution. CX, circumflex; D1, length; D2, width; D3, depth; DM, diabetes mellitus; LA, left atrium; LAA, left atrium appendage; non‐DM, nondiabetes mellitus

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