Transthoracic Echocardiographic Predictors of Left Atrial Appendage Thrombus

Ellis, Keith; Ziada, Khaled M.; Vivekananthan, Deepak P.; Latif, Ahmed Abdel; Shaaraoui, Mustaphasahim; Martin, David; Grimm, Richard A.

doi:10.1016/j.amjcard.2005.08.065

Cited by 54 publications

(35 citation statements)

References 16 publications

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“…If prospectively validated, these findings would indicate that echocardiographic diastolic function parameters may help physicians identify patients at very low risk of LAAT, given their excellent sensitivity. Previous reports have demonstrated that reduced LVEF is associated with LAAT [7,19,20]. Despite the fact that E:e’ and e’ velocity are tightly related to systolic function, [18] we demonstrated that diastolic parameters are associated with LAAT independent of LVEF, likely driven by subjects with impaired diastolic function but preserved LVEF.…”

Section: Discussioncontrasting

confidence: 50%

The value of diastolic function parameters in the prediction of left atrial appendage thrombus in patients with nonvalvular atrial fibrillation

Doukky

Garcia‐Sayan

Gage

et al. 2014

Cardiovasc Ultrasound

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BackgroundLeft ventricular diastolic impairment and consequently elevated filling pressure may contribute to stasis leading to left atrial appendage thrombus (LAAT) in nonvalvular atrial fibrillation (AF). We investigated whether transthoracic echocardiographic parameters can predict LAAT independent of traditional clinical predictors.MethodsWe conducted a retrospective cohort study of 297 consecutive nonvalvular AF patients who underwent transthoracic echocardiogram followed by a transesophageal echocardiogram within one year. Multivariate logistic regression analysis models were used to determine factors independently associated with LAAT.ResultsNineteen subjects (6.4%) were demonstrated to have LAAT by transesophageal echocardiography. These patients had higher mean CHADS2 scores [2.6 ± 1.2 vs. 1.9 ± 1.3, P = 0.009], higher E:e’ ratios [16.6 ± 6.1 vs. 12.0 ± 5.4, P = 0.001], and lower mean e’ velocities [6.5 ± 2.1 cm/sec vs. 9.1 ± 3.2 cm/sec, P = 0.001]. Both E:e’ and e’ velocity were associated with LAAT formation independent of the CHADS2 score, warfarin therapy, left ventricular ejection fraction (LVEF), and left atrial volume index (LAVI) [E:e’ odds-ratio = 1.14 (95% confidence interval = 1.03 – 1.3), P = 0.009; e’ velocity odds-ratio = 0.68 (95% confidence interval = 0.5 – 0.9), P = 0.007]. Similarly, diastolic function parameters were independently associated with spontaneous echo contrast.ConclusionThe diastolic function indices E:e’ and e’ velocity are independently associated with LAAT in nonvalvular AF patients and may help identify patients at risk for LAAT.

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Section: Discussioncontrasting

confidence: 50%

The value of diastolic function parameters in the prediction of left atrial appendage thrombus in patients with nonvalvular atrial fibrillation

Doukky

Garcia‐Sayan

Gage

et al. 2014

Cardiovasc Ultrasound

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“…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 . We intended to study the use of left atrial strain/strain rate evaluated by two‐dimensional (2D) speckle tracking method for prediction of LAA functions and the presence of thrombus, and find out its application in guiding the necessity for performing TEE in these patients.…”

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

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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.

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“…Left atrial thrombi are found in 3.2 %-18 % of patients with AF, and the incidence varies depending on the patient population [8][9][10][11]. On the other hand, ventricular thrombi occur more infrequently, being observed in patients with myocardial infarction [6,12], dilated cardiomyopathy [7], and acute myocarditis [13].…”

Section: Discussionmentioning

confidence: 97%

Resolution of a left ventricular thrombus by the thrombolytic action of dabigatran

Nagamoto¹,

Shiomi²,

Matsuura³

et al. 2013

Heart Vessels

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A 77-year-old man was referred to our cardiovascular department for detailed examination after abnormal electrocardiography findings were obtained during a preoperative cataract surgery workup. Ultrasound echocardiography (UCG) and computed tomography (CT) revealed evidence of previous myocardial infarction with anteroseptal akinesis and a left ventricular (LV) thrombus (14 × 12 mm). Dabigatran (220 mg/day) was prescribed as an outpatient treatment, and the disappearance of the LV thrombus was confirmed by UCG and CT 27 days after dabigatran initiation. No thromboembolism occurred between treatment initiation and thrombus resolution. Our results indicate that dabigatran has thrombolytic action on an acute pre-existing intracardiac thrombus.

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Transthoracic Echocardiographic Predictors of Left Atrial Appendage Thrombus

Cited by 54 publications

References 16 publications

The value of diastolic function parameters in the prediction of left atrial appendage thrombus in patients with nonvalvular atrial fibrillation

The value of diastolic function parameters in the prediction of left atrial appendage thrombus in patients with nonvalvular atrial fibrillation

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

Resolution of a left ventricular thrombus by the thrombolytic action of dabigatran

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