Left Atrial Remodeling Assessed by Transthoracic Echocardiography Predicts Left Atrial Appendage Flow Velocity in Patients With Paroxysmal Atrial Fibrillation

Abstract

SummaryAtrial fibrillation (AF) is associated with an increased risk of stroke and other thromboembolic events. Left atrial (LA) thrombus formation is closely related to LA dysfunction, particularly to decreased LA appendage flow velocity (LAA-FV) in patients with AF. We estimated LAA-FV using parameters noninvasively obtained by transthoracic echocardiography (TTE) in patients with paroxysmal AF.Echocardiographic and clinical parameters were assessed in 190 patients with nonvalvular paroxysmal AF showing sinus heart rhythm during transesophageal echocardiography (TEE) and TTE.LAA-FV (60 ± 22 cm/s) significantly correlated with the time interval between the initiation of the P-wave on ECG and that of the A-wave of transmitral flow on TTE (PA-TMF, correlation coefficient, −0.32; P < 0.001), LA dimension (LAD, −0.31; P < 0.001), septal a' velocity of tissue Doppler imaging (TDI, 0.35; P < 0.001), E/e' ratio (−0.28, P < 0.001), E velocity of transmitral flow (−0.20, P = 0.008), E/A ratio of transmitral flow (−0.18, P = 0.02), CHA2DS2-VASc score (−0.15, P = 0.04), and BNP plasma level (−0.32, P = 0.002). Multivariate analysis revealed that PA-TMF (standardized partial regression coefficient, −0.17; P = 0.03), a' velocity (0.24, P = 0.004), and LAD (−0.20, P = 0.01) were independent predictors of LAA-FV (multiple correlation coefficient R, 0.44; P < 0.001).Parameters of atrial remodeling, ie, decreased a' velocity, increased LAD, and PA-TMF during sinus rhythm may be useful predictors of LA blood stasis in patients with nonvalvular PAF. LAA-FV can be estimated using these TTE parameters instead of TEE. (Int Heart J 2016; 57: 177-182)

Feasibility and Safety of Left Atrial Appendage Closure Using the LAmbre Device in Patients with Nonvalvular Atrial Fibrillation with or Without Prior Catheter Ablation

“…The follow-up assessments for embolic events were detected based on patients' symptom and, thus, the occurrence rate might be underestimated. TEE assessment was relatively invasive and low-throughput, 32) and was performed at 3 and 12 months after LAAC and, therefore, transient thrombus formation in the interval phase after LAAC cannot be excluded. However, the relatively long follow-up time makes the data solid to interpret key events.…”

Evaluation of the left atrial appendage by real time three‐dimensional transesophageal echocardiography online

“…The data of TEE images were excluded from this study if the LAA was not visualized from at least three different angles. In addition, patients with high heart rates (heart rates ≥ 90 beats/min) were also excluded from this study because of fusion of the E‐ and A‐waves at rapid heart rates …”

Complexity of clinical status and therapeutic difficulties in 85-year-old patient with atrial fibrillation

“…Objawami echokardiograficznymi świadczącymi o zaburzonej czynności lewego przedsionka są m.in. : wymiar lewego przedsionka, wskaźnik objętości lewego przedsionka (LAVI), frakcja skracania przedsionka w M-mode, zmniejszona prędkość przepływu krwi w LAA < 20 cm/s (LAA-FV) i nasilone spontaniczne echokardiograficzne kontrastowanie (LASEC) [5]. Skrzepliny powstające w dysfunkcyjnym LAA stanowią materiał zatorowy.…”