Effect of Elevated Left Ventricular Diastolic Filling Pressure on the Frequency of Left Atrial Appendage Thrombus in Patients With Nonvalvular Atrial Fibrillation

Iwakura, Katsuomi; Okamura, Atsushi; Koyama, Yasushi; Date, Motoo; Higuchi, Yoshiharu; Inoue, Koichi; Kimura, Ryusuke; Nagai, Hirokazu; Toyoshima, Yuko; Ozawa, Makito; Ito, Norihisa; Shibuya, Masabumi; Omiya, Shigemiki; Takagi, Takashi; Morisawa, Daisuke; Fujii, Kenshi

doi:10.1016/j.amjcard.2010.09.042

Cited by 48 publications

(41 citation statements)

References 29 publications

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“…Accordingly, we suggest that diastolic dysfunction may confer risk for SEC and stroke in patients with nonvalvular AF and preserved LV ejection fraction. Similarly, in a study carried out by Ito et al (19) on 41 patients with dilated cardiomyopathy at sinus rhythm, in patients with stage 3 diastolic dysfunction, LAA flow velocity was found to be lower than those with stage 2 diastolic dysfunction (20,21). But that study enrolled patients with systolic dysfunction and sinus rythm.…”

Section: Discussionmentioning

confidence: 95%

Effect of left ventricular diastolic dysfunction on left atrial appendage function and thrombotic potential in nonvalvular atrial fibrillation

Demirçelik¹,

Çetın²,

Çiçekçioğlu³

et al. 2014

Anadolu Kardiyol Derg

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Objective: We aimed to investigate effects of left ventricular diastolic dysfunction on left atrial appendage functions, spontaneous echo contrast and thrombus formation in patients with nonvalvular atrial fibrillation. Methods: In 58 patients with chronic nonvalvular atrial fibrilation and preserved left ventricular systolic function, left atrial appendage functions, left atrial spontaneous echo contrast grading and left ventricular diastolic functions were evaluated using transthoracic and transoesophageal echocardiogram. Patients divided in two groups: Group D (n=30): Patients with diastolic dysfunction, Group N (n=28): Patients without diastolic dysfunction. Categorical variables in two groups were evaluated with Pearson's chi-square or Fisher's exact test. The significance of the lineer correlation between the degree of spontaneous echo contrast (SEC) and clinical measurements was evaluated with Spearman's correlation analysis. Results: Peak pulmonary vein D velocity of the Group D was significantly higher than the Group N (p=0.006). However, left atrial appendage emptying velocity, left atrial appendage lateral wall velocity, peak pulmonary vein S, pulmonary vein S/D ratio were found to be significantly lower in Group D (p=0.028, p<0.001, p<0.001; p<0.001). Statistically significant negative correlation was found between SEC in left atrium and left atrial appendage emptying, filling, pulmonary vein S/D levels and lateral wall velocities respectively (r=-0.438, r=-0.328, r=-0.233, r=-0.447). Left atrial appendage emptying, filling, pulmonary vein S/D levels and lateral wall velocities were significantly lower in SEC 2-3-4 than SEC 1 (p=0.003, p=0.029, p<0.001, p=0.002). Conclusion: In patients with nonvalvular atrial fibrillation and preserved left ventricular ejection fraction, left atrial appendage functions are decreased in patients with left ventricular diastolic dysfunction. Left ventricular diastolic dysfunction may constitute a potential risk for formation of thrombus and stroke. (Anadolu Kardiyol Derg 2014; 14: 256-60

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Section: Discussionmentioning

confidence: 95%

Effect of left ventricular diastolic dysfunction on left atrial appendage function and thrombotic potential in nonvalvular atrial fibrillation

Demirçelik¹,

Çetın²,

Çiçekçioğlu³

et al. 2014

Anadolu Kardiyol Derg

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show abstract

“…Actually, a high E/e' ratio was correlated to initial ischemic lesion volume on DWI in this study. Iwakura et al reported that diastolic dysfunction was associated with left atrial appendage thrombus in patients with AF [14]. Transesophageal echocardiography sometimes demonstrates large thrombus in left atrium in patients with AF.…”

Section: Discussionmentioning

confidence: 99%

Cardiac diastolic dysfunction predicts in-hospital mortality in acute ischemic stroke with atrial fibrillation

Tateishi

Tsujino

Hamabe

et al. 2014

Journal of the Neurological Sciences

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“…The Stroke Prevention in Atrial Fibrillation III trial demonstrated a 2.5-fold increase in stroke risk if appendage thrombi were visualized on TEE, 79 with an association between reduced peak LAA emptying velocity of < 20 cm/s, the presence of dense spontaneous echocardiographic contrast, thought to reflect blood stasis and red cell clumping, and appendage thrombi. 80 The close association between the presence of LAA thrombus and mitral E/e' (an estimate of elevated left ventricular filling pressures) 71,81 and B-type natriuretic peptide, 70 independently of the CHADS 2 score, is further evidence that increased diastolic ventricular pressure transmitted to the atrium is important in LAA thrombogenesis. There may be a lack of correlation between AF and LAA thrombus, 82 as LAA mechanical function may be relatively preserved during fibrillatory activity whilst significantly reduced in others that are in sinus rhythm with left ventricular diastolic dysfunction.…”

Section: Left Atrial Appendage Dysfunction and Myopathymentioning

confidence: 99%

Left Atrial Appendage Exclusion for Atrial Fibrillation

Syed

DeSimone

Friedman

et al. 2016

Heart Failure Clinics

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Effect of Elevated Left Ventricular Diastolic Filling Pressure on the Frequency of Left Atrial Appendage Thrombus in Patients With Nonvalvular Atrial Fibrillation

Cited by 48 publications

References 29 publications

Effect of left ventricular diastolic dysfunction on left atrial appendage function and thrombotic potential in nonvalvular atrial fibrillation

Effect of left ventricular diastolic dysfunction on left atrial appendage function and thrombotic potential in nonvalvular atrial fibrillation

Cardiac diastolic dysfunction predicts in-hospital mortality in acute ischemic stroke with atrial fibrillation

Left Atrial Appendage Exclusion for Atrial Fibrillation

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