P1360Association between left atrial appendage dysfunction and thromboembolic risk in nonvalvular atrial fibrillation

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
Y Mao ◽  
M M Ma ◽  
C Yu ◽  
Y Yang ◽  
Y H Wang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Stratification ◽  
Left Atrial ◽  
Strain Analysis ◽  
Roc Curves ◽  
Nonvalvular Atrial Fibrillation ◽  
Discriminative Ability ◽  
Thromboembolic Risk ◽  
Mechanical Dispersion ◽  
Peripheral Embolization

Abstract Background/Introduction:  Atrial fibrillation (AF) is associated with higher risk for thromboembolism , and the discriminative ability of the widely used CHA2DS2-VASc scores for risk stratification is modest. Although the presence of thrombus in the LAA is the most powerful predictors for thromboembolic risk, they are often absent in patients with AF and prior stroke. AF may be related to myocardial fibrosis, and even though left atrial fibrosis is associated with mechanical dispersion, this phenomenon is not well studied in LAA. We hypothesized that detection of LAA dysfunction and mechanical dispersion using strain echocardiography is useful in the identification of cardiac thromboembolism. Purpose The aim of this study was to determine the association of LAA mechanics assessed using strain analysis with previous thromboembolic events in patients with nonvalvular AF and to assess the potential incremental significance of LAA mechanical dispersion over the traditional risk stratification scheme. Methods A group of 116 patients with AF referred for TEE was prospectively analyzed. LAA strain and mechanical dispersion in parallel with other conventional TEE parameters were analyzed in terms of their association with previous embolic stroke and peripheral embolization. Results Patients with embolic events had a higher mean CHA2DS2-VASc score, higher incidence of LAA dense SEC or thrombi, and other clinical data were comparable. Patients with embolic events had greater impairment in the LA standard parameters, and lower global and regional LAA longitudinal strain than those of the controls. LAA MD was significantly higher in patients with embolization than in those without it (18.91 ± 7.19 %vs 13.8 ± 5.54%; P < .001). In ROC analysis, cut-off values for LAA MD,LAEF, LAA GLS for the presence of dense SEC/ thrombus were >20.21 % (p = 0.0076), ≤31.11 % (p = 0.017), and ≤ 7.31 % (p = 0.014), respectively. LAA MD, LAEF, LAA thrombus and CHA2DS2-VASc scores were independently associated with the presence of thromboembolism in multivariate analyses, and LAA MD had additional significance over the CHA2DS2-VASc score. Conclusion LAA MD, LAA thrombi and LAEF had statistically significant meaning for the presence of prior embolism that was independent of the standard planimetric and volumetric measurements. What’s more, LAA MD had an incremental value over CHA2DS2-VASc score in risk stratification and warrants testing in a larger study. Abstract Figure. ROC curves for LAA parameters

scholarly journals Lipoprotein(a), Left Atrial Appendage Function and Thromboembolic Risk in Patients With Chronic Nonvalvular Atrial Fibrillation

2000 ◽  
Vol 64 (2) ◽  
pp. 93-98 ◽  
Author(s):  
Yutaka Igarashi ◽  
Hidehiro Kasai ◽  
Fumio Yamashita ◽  
Tadashi Sato ◽  
Hiroshi Inuzuka ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Nonvalvular Atrial Fibrillation ◽  
Thromboembolic Risk ◽  
Lipoprotein A

scholarly journals Thromboembolic risk factors and predictors of left atrial appendage thrombosis in Far North patients with nonvalvular atrial fibrillation

2021 ◽  
Vol 26 (10) ◽  
pp. 4586
Author(s):  
N. Yu. Khorkova ◽  
T. P. Gizatulina ◽  
A. V. Belokurova ◽  
E. A. Gorbatenko ◽  
E. I. Yaroslavskaya
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Ventricular Mass Index ◽  
Left Atrial Appendage ◽  
Left Ventricular ◽  
Nonvalvular Atrial Fibrillation ◽  
Thromboembolic Risk ◽  
Far North

Aim. To analyze thromboembolic risk factors and identify additional predictors of left atrial appendage (LAA) thrombosis, which are not included in the CHA2DS2VASc scale, in long-term Far North residents with nonvalvular atrial fibrillation (AF).Material and methods. The study included 162 patients (men, 108; women, 54; mean age, 55,3±8,7 years) with non-valvular AF, living in the Far North, and 684 patients (men, 408; women, 276; mean age, 56,9±9,3 years), living in the temperate latitudes, hospitalized for catheter ablation. All patients underwent transthoracic and transesophageal echocardiography. According to transesophageal echocardiography, Far North patients were divided into two groups: group 1 — 21 patients with LAA thrombosis, group 2 — 141 patients without LAA thrombosis.Results. Compared to patients living in the temperate latitudes, Far North patients were younger (p=0,021) and were more likely to have type 2 diabetes (14,2% vs 8,3%, p=0,022), class ³II obesity (29,6% vs 21,1%, p=0,019), persistent AF(47,5% vs 33,2%, p=0,0019), LAA thrombosis (13% vs 6,6%, p=0,006), and severe structural and functional cardiac abnormalities (biatrial and right ventricular enlargement, lower left ventricular ejection fraction). In Far North patients, using logistic regression, independent predictors of LAA thrombosis were identified: an increase in left ventricular mass index (odds ratio (OR), 1,029; 95% confidence interval (CI), 1,011-1,048; p=0,001), persistent AF (OR, 3,521; 95% CI, 1,050-11,800; p=0,041).Conclusion. In Far North patients with nonvalvular AF, scheduled for catheter ablation, compared with patients from temperate latitudes, with a similar profile of cardiovascular diseases at a younger age, type 2 diabetes, grade ³II obesity, persistent AF, and LAA thrombosis were more common. The presence of persistent AF and an increase in left ventricular mass index are independent predictors of LAA thrombosis in Far North patients with nonvalvular AF.

scholarly journals The Predictive Value of PRECISE-DAPT Score for the Thrombogenic Milieu in Left Atrium and Left Atrial Appendix in the Patients with Atrial Fibrillation Planned AF Ablation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H.C Konte ◽  
E.H Cetin ◽  
M.B Ozbay ◽  
N.M Yaman ◽  
O Ozeke ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Left Atrial ◽  
Independent Predictor ◽  
Critical Role ◽  
Multivariate Logistic Regression Analysis ◽  
Roc Curves ◽  
Risk Indicators ◽  
Thromboembolic Risk ◽  
Af Ablation

Abstract Introduction and aim Atrial fibrillation (AF) is the most common arrhythmia in the clinical practice. In AF patients, the assessment of thromboembolic risk and the initiation of anticoagulant therapy to appropriate patients play critical role in management of these patients. Current guidelines recommend to use CHA2DS2VASC score in evaluation of thromboembolic risk. However, the effectiveness of this score has been questioned recently. This situation requires new risk indicators. Although PRECISE-DAPT score was initially constituted to determine the duration of dual antiplatelet therapy in patients with PCI, current studies have reported that this score may also predict thrombotic events. In this study, we aimed to evaluate the effectiveness of PRECISE-DAPT score to predict thrombogenic milieu by comparing with CHA2DS2VASC score in non valvular AF patients whom referred TEE before AF ablation procedure. Method 428 patients were included in the study. The presence of grade 2–3 SEC and thrombus in left atrium and/or left atrial appendage were accepted as thrombogenic milieu. The patients were divided into two groups according to the presence of thrombogenic milieu. In addition, we constituted three groups as grade 0–1 SEC group, grade 2–3 SEC group and thrombus group to evaluate the parameters in detail. Results Grade 2–3 SEC was found in 36 patients and thrombus was detected in 24 patients. 60 patients was included to the thrombogenic positive (artı) group while 368 patients was included to thrombogenic milieu (−) group. PRECISE-DAPT and CHA2DS2VASC scores were higher in thrombogenic positive (artı) group In multivariate logistic regression analysis, PRECISE-DAPT score was found to be an independent predictor of thrombogenic milieu (OR: 1.145, CI:1.083–1.211, p<0,001). The comparison of ROC curves was shown that PRECISE DAPT score was higher area under curve than CHA2DS2VASC score, 0,753 and 0,649 respectively. Conclusion In our study, in patients performed TEE before AF ablation, PRECISE-DAPT score was found to be an independent predictor for thrombogenic milieu presented as high grade SEC and thrombus, there by thromboembolic risk. PRECISE-DAPT score seems to be more effective than CHA2DS2VASC score. In AF patients, PRECISE-DAPT score may provide additional benefit in assessment of thromboembolic risk, thus enabling a more individual and accurate anticoagulation decision in these patients. Funding Acknowledgement Type of funding source: None

scholarly journals Comparison of left atrial and left atrial appendage mechanics in the risk stratification of stroke in patients with atrial fibrillation

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yankai Mao ◽  
Chan Yu ◽  
Yuan Yang ◽  
Mingming Ma ◽  
Yunhe Wang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Stratification ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Global Longitudinal Strain ◽  
Multivariable Analysis ◽  
Atrial Appendage ◽  
Time To Peak ◽  
Mechanical Dispersion ◽  
Echocardiographic Parameters

Abstract Background Left atrial (LA) and left atrial appendage (LAA) dysfunction has been demonstrated to contribute to atrial fibrillation (AF)-related stroke. However, usefulness of LA and LAA mechanics has not been fully compared. We sought to investigate the association of LA and LAA mechanics with stroke and to compare their diagnostic values in the risk stratification of stroke in patients with nonvalvular AF. Methods A total of 208 consecutive patients with AF (63.58 ± 10.37 years, 63.9% male,57.7% persistent AF) who underwent echocardiography before catheter ablation were prospectively enrolled. Speckle-tracking was used to measure LA and LAA global longitudinal strain (GLS). LA and LAA mechanical dispersions (MD) were defined as the standard deviation (SD) of time to peak positive strain corrected by the R-R interval. Results Patients with prior stroke/ transient ischemic attack (TIA) (n = 31) had significantly higher LA and LAA MD than those without (n = 177) (11.56 ± 4.38% vs. 8.43 ± 3.44%, 15.15 ± 5.46% vs. 10.94 ± 4.40%, both P < 0.01). In multivariable analysis, LA and LAA MD were independently associated with stroke/TIA (odds ratio, 1.18–1.29, 1.19–1.22, respectively, both P < 0.01), providing incremental values over clinical and standard echocardiographic parameters. In a subgroup analysis, LA MD was more useful than LAA MD in patients with normal LA volumes, while LAA MD was superior to LA MD in patients with LA enlargement. Conclusions Higher LA and LAA mechanical dispersion are independently associated with stroke/TIA in AF patients and had incremental values over clinical and conventional echocardiographic parameters. What’s more, priorities of dispersion assessment are different depending on patients’ LA size.

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