Feasibility and Accuracy of Automated Three-Dimensional Echocardiographic Analysis of Left Atrial Appendage for Transcatheter Closure

Background: Procedural success of transcatheter left atrial appendage closure (LAAC) is dependent on correct device selection. Three-dimensional (3D) transesophageal echocardiography (TEE) is more accurate than the two-dimensional modality for evaluation of the complex anatomy of the left atrial appendage (LAA). However, 3D transesophageal echocardiographic analysis of the LAA is challenging and highly expertise dependent. The aim of this study was to evaluate the feasibility and accuracy of a novel software tool for automated 3D analysis of the LAA using 3D transesophageal echocardiographic data. Methods: Intraprocedural 3D transesophageal echocardiographic data from 158 patients who underwent LAAC were retrospectively analyzed using a novel automated LAA analysis software tool. On the basis of the 3D transesophageal echocardiographic data, the software semiautomatically segmented the 3D LAA structure, determined the device landing zone, and generated measurements of the landing zone dimensions and LAA length, allowing manual editing if necessary. The accuracy of LAA preimplantation anatomic measurement reproducibility and time for analysis of the automated software were compared against expert manual 3D analysis. The software feasibility to predict the optimal device size was directly compared with implanted models. Results: Automated 3D analysis of the LAA on 3D TEE was feasible in all patients. There was excellent agreement between automated and manual measurements of landing zone maximal diameter (bias,-0.32; limits of agreement,-3.56 to 2.92), area-derived mean diameter (bias,-0.24; limits of agreement,-3.12 to 2.64), and LAA depth (bias, 0.02; limits of agreement,-3.14 to 3.18). Automated 3D analysis, with manual editing if necessary, accurately identified the implanted device size in 90.5% of patients, outperforming twodimensional TEE (68.9%; P < .01). The automated software showed results competitive against the manual analysis of 3D TEE, with higher intra-and interobserver reproducibility, and allowed quicker analysis (101.9 +/- 9.3 vs 183.5 +/- 42.7 sec, P < .001) compared with manual analysis. Conclusions: Automated LAA analysis on the basis of 3D TEE is feasible and allows accurate, reproducible, and rapid device sizing decision for LAAC. (J Am Soc Echocardiogr 2022;35:124-33.)

Automated summary

This study evaluated the feasibility and accuracy of a novel software tool for automated 3D analysis of the left atrial appendage (LAA) using 3D transesophageal echocardiographic data. The results showed that the automated software accurately determined the LAA size and had higher reproducibility and faster analysis compared to traditional 2D echocardiography.