Abstract 17979: Left Atrial Cross Sectional Area is a Novel Echocardiographic Measure Which Improves the Predictive Value of Chads2 Score in Risk Stratification of Cardioembolic Strokes

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Timothy C Tan ◽  
Mark Handschumacher ◽  
Octavio M Pontes-Neto ◽  
Maria C Nunes ◽  
Yong H Park ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Risk Prediction ◽  
Left Atrial ◽  
Stroke Risk ◽  
Thrombus Formation ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Chads2 Score ◽  
Cross Sectional ◽  
C Statistic

Background: Cardioembolic (CE) stroke carries significant morbidity and mortality. Current risk stratification tools such as CHADS2 score do not include any imaging parameters and are based on clinical features, which have limitations. Left atrial (LA) enlargement and remodeling may be associated with CE risk due to predisposition for atrial arrhythmias and thrombus formation. Left atrial cross sectional area (LACSA), a novel echo measure which reflects both LA size and shape, may improve CE stroke risk assessment. Aim: This study examined the value of LACSA in predicting CE stroke risk and the improvement in risk prediction when added to CHADS2 score. Methods: Clinical and echo parameters were examined in a prospective cohort of 1275 consecutive patients with ischemic stroke. Strokes were classified using the Causative Classification of Strokes and 259 (20%) were classified as CE stroke. LACSA was calculated using the formula: π/4*largest measured LA diameter*smallest measured LA diameter where mid LA diameter was measured in the parasternal long axis, 4 chamber and 2 chamber views. Results: Patients with CE stroke had greater LACSA (8.6 ± 2.3 vs 6.4 ± 1.8 cm2/m2; p<0.001) and mean CHADS2 score (2.25 ± 1.28 vs 1.87 ± 1.40; p<0.0001) compared to non-CE stroke patients. LACSA was independently associated with CE strokes (OR 1.21; 95% CI 1.08-1.34; p=0.001) in a multivariable model adjusted for CHADS2, gender, score, BMI, atrial fibrillation, anti-platelet and anti-coagulant use, E/E’ and LVEF. The addition of LACSA to CHADS2 score improved the prediction of CE stroke (c-statistic for predicting CE stroke using CHADS2 alone was 0.59 (95% CI 0.55-0.63) vs CHADS2 and LACSA 0.78 (95% CI 0.72-0.80) (p<0.001). Conclusion: LACSA is a novel measure of LA remodeling and associated with CE stroke. LACSA, an imaging parameter, enhances the risk prediction of the CHADS2 score, a clinical measure of risk, improving risk stratification for CE stroke and impacting therapeutic strategies.

Abstract 13136: Left Atrial Appendage Structural Characteristics Predict Thrombus Formation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hyun Kim ◽  
John Ning ◽  
Kaiwei Lu ◽  
Colton Thompson ◽  
Sudhi Tyagi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Thrombus Formation ◽  
Structural Characteristics ◽  
Cross Sectional Area ◽  
Atrial Appendage ◽  
Case Group ◽  
Sectional Area ◽  
Cross Sectional

Introduction: Atrial fibrillation remains highly prevalent in the US with over 6 million diagnosed individuals. Discordant atrial contraction inherent to atrial fibrillation results in stagnant blood flow and increases the risk for thrombus formation particularly within the left atrial appendage (LAA). Anticoagulation is the mainstay of intracardiac thrombus prevention and is initiated based on the CHAD 2 S 2 -VASc risk score that does not account for LAA morphology. The relationship between LAA structural characteristics and thrombus development remains poorly understood. Hypothesis: We hypothesized that in patients with atrial fibrillation, LAA structural characteristics correlate with the presence of thrombus. Methods: We performed a retrospective case-control study of 151 subjects with a history of atrial fibrillation who underwent transesophageal echocardiogram (TEE) to evaluate the LAA for pre-cardioversion indication or Watchman screening evaluation. Subjects discovered to have LAA thrombus on TEE defined the study case group (n = 74) while control subjects did not have LAA thrombus (n = 77). Baseline demographics and echocardiographic characteristics were collected for all subjects. Results: Subjects without thrombus were older than those with thrombus (thrombus: 68.6 ± 13.1 years, no thrombus: 74.7 ± 9.2 years, p = 0.001 ). LAA ostial cross-sectional area was smaller in subjects with thrombus than those without thrombus (thrombus: 251.1 ± 117.4 mm 2 , no thrombus: 332.9 ± 171.2 mm 2 , p < 0.001 ). This finding remained significant in both unadjusted and adjusted logistic regression models ( Table 1 ). CHA 2 DS 2 -VASc score did not significantly differ in those with or without thrombus (thrombus: 4.4 ± 1.8, no thrombus: 4.3 ± 1.7, p = 0.822). Conclusions: Smaller LAA ostial cross-sectional area correlates with thrombus formation. Consideration of LAA structural characteristics may improve precision of anticoagulation management.

Left atrial cross-sectional area is a novel measure of atrial shape associated with cardioembolic strokes

Heart ◽  
2020 ◽  
Vol 106 (15) ◽  
pp. 1176-1182
Author(s):  
Timothy C Tan ◽  
Maria Carmo Pereira Nunes ◽  
Mark Handschumacher ◽  
Octavio Pontes-Neto ◽  
Yong-Hyun Park ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Flow Velocity ◽  
Left Atrial ◽  
Velocity Profiles ◽  
Left Ventricular ◽  
Cross Sectional Area ◽  
Left Ventricular Ejection ◽  
Sectional Area ◽  
Cross Sectional

ObjectiveCardioembolic (CE) stroke carries significant morbidity and mortality. Left atrial (LA) size has been associated with CE risk. We hypothesised that differential LA remodelling impacts on pathophysiological mechanism of major CE strokes.MethodsA cohort of consecutive patients hospitalised with ischaemic stroke, classified into CE versus non-CE strokes using the Causative Classification System for Ischaemic Stroke were enrolled. LA shape and remodelling was characterised by assessing differences in maximal LA cross-sectional area (LA-CSA) in a cohort of 40 prospectively recruited patients with ischaemic stroke using three-dimensional (3D) echocardiography. Flow velocity profiles were measured in spherical versus ellipsoidal in vitro models to determine if LA shape influences flow dynamics. Two-dimensional (2D) LA-CSA was subsequently derived from standard echocardiographic views and compared with 3D LA-CSA.ResultsA total of 1023 patients with ischaemic stroke were included, 230 (22.5%) of them were classified as major CE. The mean age was 68±16 years, and 464 (45%) were women. The 2D calculated LA-CSA correlated strongly with the LA-CSA measured by 3D in both end-systole and end-diastole. In vitro flow models showed shape-related differences in mid-level flow velocity profiles. Increased LA-CSA was associated with major CE stroke (adjusted relative risk 1.10, 95% CI 1.04 to 1.16; p<0.001), independent of age, gender, atrial fibrillation, left ventricular ejection fraction and CHA2DS2-VASc score. Specifically, the inclusion of LA-CSA in a model with traditional risk factors for CE stroke resulted in significant improvement in model performance with the net reclassification improvement of 0.346 (95% CI 0.189 to 0.501; p=0.00001) and the integrated discrimination improvement of 0.013 (95% CI 0.003 to 0.024; p=0.0119).ConclusionsLA-CSA is a marker of adverse LA shape associated with CE stroke, reflecting importance of differential LA remodelling, not simply LA size, in the mechanism of CE risk.

364 Left Atrial Cross Sectional Area as a Measure of Left Atrial Remodelling in Patients With Hypertension and Diabetes.

2020 ◽  
Vol 29 ◽  
pp. S200-S201
Author(s):  
F. Fernandez ◽  
S. Nawaz ◽  
A. Bhat ◽  
H. Chen ◽  
A. Fernandez ◽  
...  
Keyword(s):  
Left Atrial ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Cross Sectional ◽  
Atrial Remodelling

Pelvic Canal Narrowing Caused by Triple Pelvic Osteotomy in the Dog

1994 ◽  
Vol 07 (03) ◽  
pp. 110-113 ◽  
Author(s):  
D. L. Holmberg ◽  
M. B. Hurtig ◽  
H. R. Sukhiani
Keyword(s):  
Postoperative Complications ◽  
Pelvic Osteotomy ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Cross Sectional ◽  
Canal Width ◽  
Operative Complications ◽  
Post Operative Complications

SummaryDuring a triple pelvic osteotomy, rotation of the free acetabular segment causes the pubic remnant on the acetabulum to rotate into the pelvic canal. The resulting narrowing may cause complications by impingement on the organs within the pelvic canal. Triple pelvic osteotomies were performed on ten cadaver pelves with pubic remnants equal to 0, 25, and 50% of the hemi-pubic length and angles of acetabular rotation of 20, 30, and 40 degrees. All combinations of pubic remnant lengths and angles of acetabular rotation caused a significant reduction in pelvic canal-width and cross-sectional area, when compared to the inact pelvis. Zero, 25, and 50% pubic remnants result in 15, 35, and 50% reductions in pelvic canal width respectively. Overrotation of the acetabulum should be avoided and the pubic remnant on the acetabular segment should be minimized to reduce postoperative complications due to pelvic canal narrowing.When performing triple pelvic osteotomies, the length of the pubic remnant on the acetabular segment and the angle of acetabular rotation both significantly narrow the pelvic canal. To reduce post-operative complications, due to narrowing of the pelvic canal, overrotation of the acetabulum should be avoided and the length of the pubic remnant should be minimized.

DETERMINATION OF THE FUNCTION OF THE ROD’S CROSS-SECTIONAL AREA USING VIBRATION EIGENFREQUENCIES

2020 ◽  
Vol 0 (4) ◽  
pp. 19-24
Author(s):  
I.M. UTYASHEV ◽  
◽  
A.A. AITBAEVA ◽  
A.A. YULMUKHAMETOV ◽  
◽  
...  
Keyword(s):  
Cross Sectional Area ◽  
Variable Cross ◽  
Sectional Area ◽  
Longitudinal Vibrations ◽  
Cross Sectional ◽  
Method Error ◽  
Various Boundary Conditions ◽  
Elastic Fixation ◽  
Crosssectional Area

The paper presents solutions to the direct and inverse problems on longitudinal vibrations of a rod with a variable cross-sectional area. The law of variation of the cross-sectional area is modeled as an exponential function of a polynomial of degree n . The method for reconstructing this function is based on representing the fundamental system of solutions of the direct problem in the form of a Maclaurin series in the variables x and λ. Examples of solutions for various section functions and various boundary conditions are given. It is shown that to recover n unknown coefficients of a polynomial, n eigenvalues are required, and the solution is dual. An unambiguous solution was obtained only for the case of elastic fixation at one of the rod’s ends. The numerical estimation of the method error was made using input data noise. It is shown that the error in finding the variable crosssectional area is less than 1% with the error in the eigenvalues of longitudinal vibrations not exceeding 0.0001.

Changes in the parameters of nasal breathing and parameters of the upper respiratory tract during orthognathic operations in patients with II and III skeletal class of jaw anomalies

2020 ◽  
pp. 22-27
Author(s):  
S.Sh. Gammadaeva ◽  
M.I. Misirkhanova ◽  
A.Yu. Drobyshev
Keyword(s):  
Respiratory Tract ◽  
Nasal Cavity ◽  
Nasal Septum ◽  
Cross Sectional Area ◽  
Upper Respiratory Tract ◽  
Sectional Area ◽  
Nasal Breathing ◽  
Cross Sectional ◽  
Skeletal Class ◽  
Upper Respiratory

The study analyzed the functional parameters of nasal breathing, linear parameters of the nasal aperture, nasal cavity and nasopharynx, volumetric parameters of the upper airways in patients with II and III skeletal class of jaw anomalies before and after orthognathic surgery. The respiratory function of the nose was assessed using a rhinomanometric complex. According to rhinoresistometry data, nasal resistance and hydraulic diameter were assessed. According to the data of acoustic rhinometry, the minimum cross-sectional area along the internal valve, the minimum cross-sectional area on the head of the inferior turbinate and nasal septum and related parameters were estimated. According to the CBCT data, the state of the nasal septum, the inferior turbinates, the nasal aperture, the state of the nasal cavity, and the linear values of the upper respiratory tract (nasopharynx) were analyzed. The patients were divided into 4 groups according to the classification of the patency of the nasal passages by

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