Transthoracic echo/Doppler in the identification of patients with chronic non-valvular atrial fibrillation at risk for thromboembolic events

Pop, Gheorghe; Meeder, Han; Roelandt, J. R. T. C.; Oudenaarden, Wynsen van; Bulens, C.; Verweu, W.; Gusbers, C.; Domburg, R. van; Koudstaal, Peter J.

doi:10.1093/oxfordjournals.eurheartj.a060428

Cited by 24 publications

(7 citation statements)

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“…These parameters were quantified in several consecutive measurements in diastole for an average R-R interval as measured by continuous monitoring during echocardiography. This technique is in line with former study protocols (10).…”

Section: Study Populationsupporting

confidence: 80%

Myocardial Perfusion in Nonischemic Dilated Cardiomyopathy With and Without Atrial Fibrillation

Range¹,

Paul²,

Schäfers³

et al. 2009

J Nucl Med

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Recent studies have shown that idiopathic atrial fibrillation (AF) is associated with diminished myocardial perfusion and perfusion reserve, which are also impaired in various forms of cardiomyopathies. In many cases, AF develops during progression of dilated cardiomyopathy (DCM) and may aggravate heart failure. This study compared myocardial perfusion between patients with nonischemic DCM with and without AF. Methods: Twelve men (age 6 SD, 55 6 12 y) who had DCM and persistent AF were compared with a group of 18 men (mean age, 43 6 15 y, P 5 not statistically significant) who had DCM and sinus rhythm and with 22 healthy controls (mean age, 47 6 13 y, P 5 not statistically significant). Myocardial blood flow (MBF) was noninvasively quantified at rest and during adenosine infusion using PET and radioactive-labeled water (H 2 15 O PET). Results: Compared with controls, DCM patients without AF showed impaired hyperemic perfusion (2.52 6 1.29 vs. 3.57 6 0.88 mL/min/mL, P 5 0.014) and perfusion reserve (2.10 6 1.01 vs. 3.37 6 0.97, P 5 0.003). However, compared with DCM patients without AF, DCM patients with AF showed an additional impairment in resting perfusion (0.82 6 0.31 mL/min/mL, P 5 0.010) and hyperemic perfusion (1.32 6 0.93 mL/min/mL, P 5 0.022), and compared with controls, DCM patients with AF showed a further diminishment of perfusion reserve (1.68 6 0.94 vs. 3.37 6 0.97, P , 0.001) accompanied by the highest coronary vascular resistance of all groups. Conclusion: Compared with patients with sinus rhythm, patients with AF have significantly reduced myocardial perfusion reserve and increased coronary resistance in nonischemic DCM. Further studies on the underlying pathomechanisms are warranted.

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Section: Study Populationsupporting

confidence: 80%

Myocardial Perfusion in Nonischemic Dilated Cardiomyopathy With and Without Atrial Fibrillation

Range¹,

Paul²,

Schäfers³

et al. 2009

J Nucl Med

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“…[213][214][215][216][217][218] Specifically, SEC, or "smoke," a swirling haze of variable density, may be detected by transthoracic or transesophageal echocardiographic imaging of the cardiac chambers and great vessels under low-flow conditions. 219 This phenomenon relates to fibrinogenmediated erythrocyte aggregation 220 and is not resolved by anticoagulation.…”

Section: Pathophysiology Of Thrombus Formationmentioning

confidence: 99%

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Fuster¹,

Rydén²,

Cannom³

et al. 2006

Circulation

1,883

589

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“…In addition, the diastolic augmentation of LAA outflow was also higher in patients with a good left ventricular ejection fraction. Pop et al [24] also demonstrated that patients with a larger transmitral inflow velocity-time integral had less incidence of left atrial SEC. As the LAA flow velocity is influenced by the loading condition of the left atrium [25], the increased left atrial pressure secondary to the increased left ventricular end-diastolic pressure might also play a role in the attenuation of LAA outflow in the patients with impaired left ventricular function.…”

Section: Effect O F Left Ventricular Function On Laa Outflowmentioning

confidence: 95%

Influence of Left Ventricular Diastole on Left Atrial Appendage Blood Flow in Patients with Nonrheumatic Atrial Fibrillation

Lin

Hsu²,

Hwang³

et al. 1997

Cardiology

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The function of the left atrial appendage (LAA) reflected by the Doppler flow velocity at the outlet of the left atrial appendage has been reported to be correlated with spontaneous echo contrast and thrombus formation. To evaluate the influence of left ventricular diastole on LAA flow during atrial fibrillation (AF), 81 patients with chronic nonrheumatic AF were studied by transesophageal echocardiography. The peak outflow velocity of LAA during ventricular diastole was higher than that during ventricular systole (0.23 ± 0.14 vs. 0.15 ± 0.13 m/s, p < 0.001). The peak inflow velocity of LAA during ventricular diastole was also higher than that during ventricular systole (0.22 ± 0.15 vs. 0.18 ± 0.11 m/s, p < 0.01). Patients with a good left ventricular ejection fraction have a significantly higher peak LAA outflow velocity and a larger diastolic augmentation of LAA outflow (defined by the difference of LAA outflow between systolic and diastolic phases) than patients with an impaired left ventricular function. Thus, left ventricular diastole might have an influence on LAA flow during AF. In addition, the left ventricular function might be considered a predictor of subsequent thromboembolism from the viewpoint of its effect on LAA flow in patients with nonrheumatic AF.

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Transthoracic echo/Doppler in the identification of patients with chronic non-valvular atrial fibrillation at risk for thromboembolic events

Abstract: transthoracic echo/Doppler aids in the prediction of the presence of left atrial spontaneous echo contrast and the identification of patients with non-valvular atrial fibrillation with increased cardioembolic risk, thus avoiding transoesophageal echocardiography.

Cited by 24 publications

References 0 publications

Myocardial Perfusion in Nonischemic Dilated Cardiomyopathy With and Without Atrial Fibrillation

Myocardial Perfusion in Nonischemic Dilated Cardiomyopathy With and Without Atrial Fibrillation

ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Influence of Left Ventricular Diastole on Left Atrial Appendage Blood Flow in Patients with Nonrheumatic Atrial Fibrillation

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