Decreased left atrial appendage emptying velocity as a link between atrial fibrillation type, heart failure and older age and the risk of left atrial thrombus in atrial fibrillation

Abstract

Introduction: Decreased left atrial appendage emptying velocity (LAAV) is a known predictor of LAA thrombus in atrial fibrillation (AF). The aim of our study was to identify which of the clinical risk factors for LAA thrombus are associated with decreased LAAV. Methods: The study included 1476 consecutive AF patients who underwent transesophageal echocardiography (TEE) before AF direct current cardioversion or ablation in two high-reference cardiology departments. Patients were divided into two groups: 71 (4.8%) patients with LAAV < 20 cm/s and 1405 patients (95%) with LAAV ≥ 20 cm/s. Results: Compared with patients with LAAV ≥ 20 cm/s, those with decreased LAAV were older, more often had non-paroxysmal AF, were burdened with more concomitant diseases (including hypertension, diabetes, vascular disease, and heart failure [HF]) with higher median CHA 2 DS 2-VASc score (3 [2-4] vs 2 [1-3], P < .0001), and had lower glomerular filtration rate (GFR). Prevalence of LAA thrombus was higher in patients with decreased LAAV compared with those with LAAV ≥ 20cm/s (20% vs 4.6%, P < .0001). In patients with decreased LAAV, there was no difference in the frequency of LAA thrombus between those treated with VKA and those receiving NOAC, while in patients with LAAV ≥ 20 cm/s a trend was observed towards a benefit with NOAC. In multivariate logistic regression, non-paroxysmal AF, HF and age ≥ 65 years predicted both LAAV < 20 cm/s and LAA thrombus, while GFR < 60 mL/min/1.73 m 2 predicted only the presence of LAA thrombus. Conclusion: One in five AF patients with decreased LAAV had LAA thrombus, regardless of the type of OAC. Non-paroxysmal AF, HF and age ≥ 65 years might increase LAA thrombus risk via reduced LAAV.

Differences in the predictors of left atrial appendage thrombus between men and women treated with dabigatran or rivaroxaban

“…HF is a component of all thromboembolic risk scores. [19] In our study, patients with LAAT significantly more often had HF. In the univariable logistic regression analysis, it was a strong predictor of LAAT both in men and women.…”

Increased hemoglobin A1c level associates with low left atrial appendage flow velocity in patients of atrial fibrillation

“…Compared with younger patients, Ilercil [25] found that older patients had lower LAAV despite higher LVEF, smaller left ventricle size, and similar LA and LAA volumes. Gawałko's study [24] showed that age>65 years independently related to LAAV<20 cm/s. Female gender is one variable in CHA2DS2-VASc score, which represents the risk of stroke for AF.…”

“…Patients with AF, especially persistent AF have longer AF duration, more severe AF burdens and LA structural remodeling [29] and thus probably associate with lower LAAV. Gawałko's study [24] showed that non-paroxysmal AF might increase LAA thrombus risk via reduced LAAV. Age is an independent risk factor for thromboembolism in AF and a few studies have found that LAAV decreases with age [25,28].…”

Spontaneous left atrial echo contrast, mitral annular systolic velocity, and left atrial appendage late emptying velocity in predicting improvement of left atrial function after percutaneous balloon mitral valvuloplasty

“…Using the LAAEV as a marker for inactive LAA, our study found that a value of 25 cm/sec was the cut-off point for inactive LAA, which is consistent with Mukhopadhyay et al [29], who studied 100 patients with severe rheumatic mitral stenosis to determine the prevalence of inactive LAA, but this value is higher than Gawako et al who defined the cut-off value of LAAEV to be 20 cm/sec, which could be a factor in predicting inactive LAA. Nonetheless, this difference could be an indicator of a different pathology [30]…”