Left Atrial Appendage Flow Velocity as a Quantitative Surrogate Parameter for Thromboembolic Risk: Determinants and Relationship to Spontaneous Echocontrast and Thrombus Formation–A Transesophageal Echocardiographic Study in 500 Patients with Cerebral Ischemia

Handke, Michael; Harloff, Andreas; Hetzel, Andreas; Olschewski, Manfred; Bode, Christoph; Geibel, Annette

doi:10.1016/j.echo.2005.05.006

Cited by 173 publications

(113 citation statements)

References 28 publications

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“…The clinical characteristics of these patients, however, did not differ from those of typical AF patients at our institution 21,22 or participants of large multicenter registries. 3,4,9 Third, the blood type was not measured. Blood type O is associated with lower than normal values of circulating VWF.…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Blood Stasis and Von Willebrand Factor–ADAMTS13 Homeostasis in Atrial Fibrillation

Ammash

Konik

McBane

et al. 2011

ATVB

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Objective-Left atrial blood stasis is associated with increased risk for left atrial appendage thrombus (LAAT) and stroke in atrial fibrillation (AF). Von Willebrand factor (VWF) is associated with thromboembolism in AF. VWF thrombogenic activity is proportional to multimer size, which is regulated by VWF-cleaving protease (ADAMTS13). Methods and Results-To assess the association between left atrial blood stasis and VWF-ADAMTS13 system, plasma VWF antigen (VWF:Ag), VWF activity (VWF:Act), and ADAMTS13 activity were measured in 414 consecutive patients with nonvalvular AF (age 63Ϯ13 years; 25% women) and in 100 patients (age 64Ϯ14 years; 39% women) with normal sinus rhythm. Key Words: stroke Ⅲ thrombosis Ⅲ von Willebrand factor Ⅲ atrial fibrillation C ardioembolic stroke in the setting of atrial fibrillation (AF) begins with the left atrial appendage thrombus (LAAT) formation. 1-3 The risk for LAAT development and stroke increases with left atrium mechanical function deterioration that is reflected by reduction in left atrial appendage emptying velocity (LAAEV), development of spontaneous echocardiographic contrast (SEC), and progression of left atrial distension. 4 -7 However, the underlying mechanism behind the relationship between AF, atrial stasis, and thrombotic propensity is complex and poorly understood.Von Willebrand factor (VWF) a large plasma glycoprotein that mediates platelet adhesion and aggregation, 8 has been associated with stroke risk in AF. 9 -13 Prior studies comparing VWF levels between AF patients and subjects in normal sinus rhythm (NSR) were limited by small sample size. 14 -16 Assessment of archived plasma samples from Stroke Prevention in Atrial Fibrillation III participants lacked a comparator. 9 -11 Moreover, a prior association between elevated VWF and stroke became nonsignificant after adjustment for other clinical predictors. 11 The association between VWF and AF therefore remains largely unexplored.The thrombogenic potential of VWF is directly proportional to VWF activity (VWF:Act) determined by both plasma concentration and multimer size, 17 which is regulated by VWF-specific protease ADAMTS13. 18 Two patients may have similar plasma VWF content, yet thrombotic propensity will vary considerably depending on the proportion of highmolecular-weight multimer content. This nuance would be missed if mere antigen content was assessed.Atrial distension is associated with overexpression of VWF multimers, 19 and blood stasis has been shown to downregulate ADAMTS13 activity. 20 Previous studies, however, have not systematically accounted for degrees of atrial stasis or measured complete variables within the VWF system. We hypothesized that atrial distension and stasis in AF are associated with the higher VWF and increased proportion of large multimers that lead to the development of LAAT. To address this hypothesis, transesophageal echocardiography (TEE) measures of stasis and LAAT and measures of VWF antigen (VWF:Ag), VWF:Act, and ADAMTS13 activity were compared in consecutive patients wi...

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Section: Discussionmentioning

confidence: 99%

Left Atrial Blood Stasis and Von Willebrand Factor–ADAMTS13 Homeostasis in Atrial Fibrillation

Ammash

Konik

McBane

et al. 2011

ATVB

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“…In addition to evaluation of the aortic valve stenosis and measurements of the aortic annulus diameter, transesophageal echocardiography was also used to detect potential sources of cerebral embolism, such as spontaneous echo contrast, presence of intracardiac thrombi, low left atrial appendage peak velocities of Ͻ55 cm/s as measured by pulsed-wave Doppler, 25 patent foramen ovale or other intracardiac shunts, and atheromatous disease of the aorta. Aortic atheroma, thickness of the atheroma, and the characteristics of the atheroma (mobile/protruding/sessile) in the ascending aorta, aortic arch, and descending thoracic aorta were determined.…”

Section: Preoperative Assessment Of Potential Sources Of Embolismmentioning

confidence: 99%

Silent and Apparent Cerebral Ischemia After Percutaneous Transfemoral Aortic Valve Implantation

Kahlert

Knipp²,

Schlamann³

et al. 2010

Circulation

480

297

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Background-The risk of stroke after transfemoral aortic valve implantation (TAVI) due to dislodgement and subsequent embolization of debris from aortic arch atheroma or from the calcified valve itself ranges between 2% and 10%. The rate of clinically silent cerebral ischemia is unknown but may be even higher. Methods and Results-Thirty-two patients who underwent TAVI with the use of a balloon-expandable (nϭ22) or self-expandable (nϭ10) stent valve prosthesis were included in this descriptive study and compared with a historical control group of 21 patients undergoing open surgical aortic valve replacement. Periprocedural apparent and silent cerebral ischemia was assessed by neurological testing and serial cerebral diffusion-weighted magnetic resonance imaging at baseline, at 3.4 (2.5 to 4.4) days after the procedure, and at 3 months. TAVI was successful in all patients. After the procedure, new foci of restricted diffusion on cerebral diffusion-weighted magnetic resonance imaging were found in 27 of 32 TAVI patients (84%)

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“…Transesophageal echocardiography was mandatory as part of the preinterventional TAVI evaluation and was used to detect spontaneous echo contrast, intracardiac thrombi, low left atrial appendage peak velocities of Ͻ55 cm/s by pulsed-wave Doppler, 17 patent foramen ovale, or other intracardiac shunts, as well as aortic atheromata. Presence, thickness, and characteristics of the atheroma (mobile/protruding/sessile) in the ascending aorta, aortic arch, and descending thoracic aorta were graded as absent, mild (Ͻ4 mm without complex features), moderate (Ͼ4 mm without complex features), or severe (any size with protruding or mobile components).…”

Section: Preoperative Assessment Of Potential Sources Of Embolismmentioning

confidence: 99%

Cerebral Embolization During Transcatheter Aortic Valve Implantation

et al. 2012

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Background-Transcatheter aortic valve implantation (TAVI) is associated with a higher risk of neurological events for both the transfemoral and transapical approach than surgical valve replacement. Cerebral magnetic resonance imaging has revealed more new, albeit clinically silent lesions from procedural embolization, yet the main source and predominant procedural step of emboli remain unclear. 001).Overall, there were no significant differences between transfemoral and transapical TAVI or between the MCV and ES prostheses. No HITS were detected at baseline or 3-month follow-up. There was 1 major procedural stroke that resulted in death and 1 minor procedural stroke with full recovery at 3-month follow-up in the MCV group. Conclusions-Procedural HITS were detected by transcranial Doppler in all patients. Although no difference was observed between the transfemoral and the transapical approach with the balloon-expandable ES stent valve, transfemoral TAVI with the self-expandable MCV prosthesis resulted in the greatest number of HITS, predominantly during implantation. (Circulation. 2012;126:1245-1255.)

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Left Atrial Appendage Flow Velocity as a Quantitative Surrogate Parameter for Thromboembolic Risk: Determinants and Relationship to Spontaneous Echocontrast and Thrombus Formation–A Transesophageal Echocardiographic Study in 500 Patients with Cerebral Ischemia

Cited by 173 publications

References 28 publications

Left Atrial Blood Stasis and Von Willebrand Factor–ADAMTS13 Homeostasis in Atrial Fibrillation

Left Atrial Blood Stasis and Von Willebrand Factor–ADAMTS13 Homeostasis in Atrial Fibrillation

Silent and Apparent Cerebral Ischemia After Percutaneous Transfemoral Aortic Valve Implantation

Cerebral Embolization During Transcatheter Aortic Valve Implantation

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