Severely reduced left atrial appendage function: A cause of embolic stroke in patients in sinus rhythm?☆☆☆★

Kamalesh, Masoor; Copeland, Tiffany; Sawada, Stephen

doi:10.1016/s0894-7317(98)70011-2

Cited by 40 publications

(15 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In our study, similar to some reports (Kamalesh et al 1998;Ozer et al 2000), thrombus was found only in one patient (1.6%), in whom LAA contraction velocity was < 30 cm/sec. None of our patients with a LAA contraction velocity greater than 56 cm/sec had SEC or thrombus on TEE corresponding to a negative predictive value of 100%.…”

Section: Discussionsupporting

confidence: 92%

Transthoracic Echocardiographic Predictors of the Left Atrial Appendage Contraction Velocity in Stroke Patients with Sinus Rhythm

Uslu

Nurkalem

Orhan

et al. 2006

Tohoku J. Exp. Med.

View full text Add to dashboard Cite

Systemic embolization is a potential complication in patients with thrombi situated in the left atrium and particularly, in the left atrial appendage (LAA). Reduced LAA contraction velocities, determined by the transesophageal echocardiography (TEE), are associated with increased risk of LAA spontaneous echocontrast and thrombus formation, and a history of systemic embolism. However, TEE remains a semi-invasive procedure, limiting its serial application as a screening tool. Therefore, it is desirable to obtain information regarding LAA function by transthoracic echocardiography in patients having cardioembolic stroke. The present study was designed to investigate various echocardiographic variables for patients with stroke to predict LAA dysfunction, reflected as reduced LAA contraction velocity. We studied a total of 61 patients with newly diagnosed acute embolic stroke (42 patients) and transient ischemic attack (19 patients). Computerized tomographic scanning was performed for the diagnosis of embolic stroke. Left atrial functional parameters determined by transthoracic echocardiography, such as left atrial active emptying fraction and acceleration slope of mitral inflow A wave, had significant correlations with the LAA contraction velocity (r = 0.57, p < 0.001; r = 0.54, p < 0.001, respectively). Left atrial volume index, left atrial active emptying volume and left atrial fractional shortening were also correlated with LAA contraction velocity (r = −0.44, p < 0.001; r = 0.38, p = 0.003; r = 0.37, p = 0.004, respectively). In conclusion, transthoracic echocardiography can provide valuable and reliable information about the LAA contraction velocity in stroke patients with sinus rhythm. This finding gives new insights for the appropriate strategy in the evaluation of an acute ischemic stroke. left atrial appendage contraction velocity; transthoracic echocardiography; transesophageal echocardiography

show abstract

Section: Discussionsupporting

confidence: 92%

Transthoracic Echocardiographic Predictors of the Left Atrial Appendage Contraction Velocity in Stroke Patients with Sinus Rhythm

Uslu

Nurkalem

Orhan

et al. 2006

Tohoku J. Exp. Med.

View full text Add to dashboard Cite

show abstract

“…Significant left ventricular systolic 12,17 and/or diastolic dysfunction, 3 which were common in our study population (35% of our patients), predispose to LA thrombus formation via their secondary effect on LA hemodynamics. 18 Notably, patients with cardiac amyloidosis constitute a specific highrisk group in whom LA thrombus may occur in SR as a result of restrictive ventricular physiology as well as amyloid infiltration within the atrial myocardium, 19 both contributing to atrial dysfunction.…”

Section: Left Ventricular Dysfunctionmentioning

confidence: 84%

Clinical and Echocardiographic Characteristics of Patients With Left Atrial Thrombus and Sinus Rhythm

et al. 2002

View full text Add to dashboard Cite

Background-Left atrial (LA) thrombus is infrequently detected in the presence of sinus rhythm (SR) and, in these cases, is usually associated with additional cardiac pathologies. We sought to determine the clinical and echocardiographic characteristics of patients with LA thrombus and SR to define a high-risk group of patients prone to this uncommon clinical presentation. Methods and Results-The institution's echocardiographic laboratory database was searched to identify patients with LA thrombus, diagnosed by transesophageal echocardiography (TEE), who were in SR during the TEE examination. Of 20 643 consecutive TEE examinations performed during an 11-year period, LA thrombus was detected in 314 patients in 380 TEE examinations. Of these, SR was present in 20 patients (age 69Ϯ13 years; 40% men) in 23 examinations (0.1% of all TEE examinations; 6.1% of TEE examinations with LA thrombus). High-risk structural heart disease (severe left ventricular dysfunction or significant left-sided valve disease [predominantly mitral valve disease]), previous documented episodes of atrial fibrillation, or both (structural heart disease and previous atrial fibrillation) were present in 10, 4, and 5 of the 20 patients, respectively.

show abstract

“…Thus, the use of TEE in addition to transthoracic echocardiography (TTE) in patients who have suspected cardioembolism but in normal sinus rhythm with no structural abnormality is controversial . Nevertheless, some TEE‐based studies have shown that the flow in left atrial appendage (LAA) was impaired and even thrombus could be present in these patients although they were in sinus rhythm with no overt structural abnormality . Evaluation of LAA functions using only TTE in these patients have been a popular topic of study recently .…”

mentioning

confidence: 99%

Left Atrial Deformation Parameters Predict Left Atrial Appendage Function and Thrombus in Patients in Sinus Rhythm with Suspected Cardioembolic Stroke: A Speckle Tracking and Transesophageal Echocardiography Study

et al. 2013

View full text Add to dashboard Cite

The aim of this study was to evaluate left atrial deformations using speckle tracking echocardiography for predicting left atrial appendage (LAA) thrombus in patients with suspected cardioembolic stroke who were in normal sinus rhythm. A total of 153 ischemic stroke patients (89 males, 64 females) in sinus rhythm who were suspected of having cardioembolism were included in the study. The patients underwent conventional two-dimensional (2D) echocardiogram and 2D speckle tracking echocardiogram of the left atrium. Left atrial peak strain (LA-4C-RES) and left atrial precontraction strain (LA-4C-PUMP) were measured. Patients were divided into 2 groups according to the presence of thrombus in the LAA in transesophageal echocardiography. Both LA-4C-RES and LA-4C-PUMP values were found to be significantly lower in patients with LAA thrombus (11.8 ± 1.4% vs. 33 ± 12%, P < 0.001 and 5.8 ± 1.3% vs. 14.2 ± 5.3%, P < 0.001, respectively). A good inverse correlation was present between LA-4C-RES values and LAA morphologic parameters (with LAA area: r = -0.70, P < 0.001, with LAA length: r = -0.60, P < 0.001), and a good positive correlation was present with LAA emptying velocity with pulse Doppler (r = 0.74, P < 0.001). The area under the receiver-operating characteristic curve of the LA-4C-RES was 0.94 (0.90-0.98, P < 0.001), for the LA-4C-PUMP, the area was 0.92 (0.87-0.96, P < 0.001) to predict LAA thrombus. Left atrial deformation parameters measured by 2D speckle tracking method was found to predict impaired LAA functions and the presence of LAA thrombus in ischemic stroke patients with suspected cardioembolism, but who are in sinus rhythm.

show abstract

Severely reduced left atrial appendage function: A cause of embolic stroke in patients in sinus rhythm?☆☆☆★

Cited by 40 publications

References 6 publications

Transthoracic Echocardiographic Predictors of the Left Atrial Appendage Contraction Velocity in Stroke Patients with Sinus Rhythm

Transthoracic Echocardiographic Predictors of the Left Atrial Appendage Contraction Velocity in Stroke Patients with Sinus Rhythm

Clinical and Echocardiographic Characteristics of Patients With Left Atrial Thrombus and Sinus Rhythm

Left Atrial Deformation Parameters Predict Left Atrial Appendage Function and Thrombus in Patients in Sinus Rhythm with Suspected Cardioembolic Stroke: A Speckle Tracking and Transesophageal Echocardiography Study

Contact Info

Product

Resources

About