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.

scholarly journals Inhibition of renin-angiotensin axis reduces the risk of thrombus formation in the left atrial appendage in patients with hypertension complicated by atrial fibrillation

2018 ◽  
Vol 19 (2) ◽  
pp. 147032031878262 ◽  
Author(s):  
Ya Suo ◽  
Zhiwei Zhang ◽  
Huaying Fu ◽  
Yue Zhang ◽  
Meng Yuan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Thrombus Formation ◽  
Atrial Appendage ◽  
Renin Angiotensin ◽  
Echocardiographic Parameters ◽  
Hemostatic Markers ◽  
Ras Inhibitors

Aims: We examined whether the use of a renin-angiotensin-aldosterone system (RAS) inhibitor plays a role in protecting against left atrial appendage thrombus (LAAT) in patients with hypertension complicated by atrial fibrillation (AF). Methods: Two observational studies were conducted on patients with diagnoses of hypertension and AF, who were categorized into RAS inhibitor user or nonuser groups. Demographic characteristics, clinical characteristics, echocardiographic parameters and hemostatic markers were examined and the occurrence of LAAT during follow-up were recorded. Results: In the first study ( n = 131), LA peak systolic strain and LAA emptying flow velocity (LAA eV) were significantly increased in patients on RAS inhibitors compared with the nonuser group ( p < 0.05). Lower D-dimer and fibrinogen levels were observed in patients on RAS inhibitors ( p < 0.05). In the second study ( n = 99), 25.9% ( n = 11) of patients on RAS inhibitors developed LAAT, compared with 46.7% ( n = 21) in the nonuser group ( p < 0.05). After controlling for risk factors related to LAAT, use of RAS inhibitors remained associated with a significantly lower risk of developing LAAT (HR, 0.406; 95% CI, 0.191–0.862; p = 0.019). Conclusions: RAS inhibitors use was associated with a significant reduction in the risk of LAAT in patients with hypertension and AF.

scholarly journals Predictive Value of Left Atrial Appendage Functional Parameters on Left Atrial Thrombus or Spontaneous Echo Contrast in Patients with Nonvalvular Atrial Fibrillation

2022 ◽  
Author(s):  
Changsheng Ma ◽  
Li Wang ◽  
Yuzhu Miao ◽  
Jiali Fan ◽  
Bingyuan Zhou ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Thrombus Formation ◽  
Atrial Appendage ◽  
Control Group ◽  
Nonvalvular Atrial Fibrillation ◽  
Increased Risk ◽  
High Incidence ◽  
Echocardiographic Parameters

Abstract Background: Left atrial appendage (LAA) spontaneous echocardiographic contrast (SEC), sludge and thrombus were associated with a high incidence of thrombus formation and thromboembolic events in patients with non-valvular atrial fibrillation (AF). We aim to identify the main echocardiographic parameters associated with LAA SEC or LAA sludge/thrombus in nonvalvular AF patients.Methods and results: 298 patients with nonvalvular atrial fibrillation were included in the current study between September 2019 and January 2021. Transthoracic echocardiography and transesophageal echocardiography were performed before scheduled electrical cardioversion. LA diameter and maximum left atrial appendage area were increased in the LAA SEC group than control group, and were further increased in patients with LAA sludge or thrombus. LAA-EV, LAA-FV, anterior mitral annular plane systolic excursion (MAPSE) and LAA FAC were lower in the group with LAA SEC than control group, and were further reduced in LAA sludge or thrombus group. Lower LAA FAC and anterior MAPSE were associated with an increased risk of LAA SEC or LAA sludge/thrombus, and LAA FAC and anterior MAPSE showed high accuracy on predicting LAA SEC or LAA sludge/thrombus.Conclusion: Left atrial appendage FAC and anterior MAPSE improves left atrial appendage stasis in patients with nonvalvular atrial fibrillation.

scholarly journals Left atrial appendage function by strain predicts subclinical atrial fibrillation in patients with cryptogenic stroke/TIA

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
J Saberniak ◽  
L Skrebelyte-Strom ◽  
E.B Orstad ◽  
M.G Solberg ◽  
J.M Hilde ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Cryptogenic Stroke ◽  
Atrial Appendage ◽  
University Hospital ◽  
Cardiac Monitoring ◽  
Mechanical Dispersion ◽  
Patients At Risk

Abstract Background Left atrial (LA) function by strain has shown to be promising to predict clinical atrial fibrillation (AF) in patients with cryptogenic stroke/TIA. However, there is little knowledge, if this novel method may prospectively predict subclinical AF (SCAF) and moreover, if left atrial appendage (LAA) function by strain and mechanical dispersion may be more sensitive to improve prediction of SCAF. Purpose The aim of the present study was to investigate if LA and LAA function by strain could improve the prediction of SCAF in patients at risk. Methods In this prospective study (mean follow-up 859±226 days), 185 patients with cryptogenic stroke/TIA, mean age 68±13 years, 33% female and no history of clinical AF or SCAF, were included. All participants underwent 2D and 3D transesophageal and transthoracic echocardiography in sinus rhythm after index cryptogenic stroke/TIA (mean 5±3days). LAA and LA functions by phasic strain, including reservoir strain (Sr), conduit strain (Scd) and contraction strain (Sct) and mechanical dispersion of Sr were assessed. SCAF episodes were detected by cardiac monitoring during follow up (mean 257±273 days). Results LAA function by strain was decreased in those with SCAF (60/32% of all patients) compared to those without: Sr: 19.2±4.5% vs. 25.6±6.5% (p&lt;0.001), Scd: −11.0±3.1% vs. −14.4±4.5% (p&lt;0.001), Sct: −7.9±4.0% vs. −11.2±4% (p&lt;0.001), respectively, while mechanical dispersion by Sr strain was increased, 34±24ms vs. 26±20ms (p=0.02). However, LA function by strain and mechanical dispersion did not differ in patients with SCAF compared to patients without. By ROC analyses, LAA strain and mechanical dispersion were highly significant in prediction of SCAF. LAA reservoir strain showed the best AUC of 0.80 (95% CI 0.73–0.87) with a cut-off value of 22.2%, sensitivity of 80%, and specificity of 73%, p&lt;0.001. (Figure) Conclusions For the first time, we showed, that left atrial appendage function by strain and mechanical dispersion predicts SCAF, as opposed to left atrial function. Left atrial appendage function by strain may be useful in risk prediction in patients at considerable AF risk. FUNDunding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Department of Cardiology, Akershus University Hospital, Oslo/Lørenskog, Norway

scholarly journals Tissue doppler imaging of left atrial appendage during transoesophageal echocardiography predicts successful cardioversion in patients with atrial fibrillation

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
P Kostakou ◽  
V Kostopoulos ◽  
M Stamatelatou ◽  
E Tryfou ◽  
K Mihas ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Tissue Doppler Imaging ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Global Longitudinal Strain ◽  
Tissue Doppler ◽  
Electrical Cardioversion ◽  
Atrial Appendage ◽  
Doppler Imaging

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Restoration of sinus rhythm in patients with atrial fibrillation (AF) prevents from thromboembolic events, decreases the risk for cardiomyopathy and improves quality of life. Purpose This study aimed to determine whether Tissue Doppler Imaging (TDI) during transesophageal echo (TEE) could predict successful electrical cardioversion (CV) of AF lasting more than 48 hours but less than 6 months. Methods One hundred patients, 74 men and 26 women of mean age 64.7 ± 9.8 years old with non-valvular AF were included. Pulse wave (PW) Doppler velocities as well as TDI velocities of the medial and lateral walls of the left atrial appendage (LAA) were recorded during TEE before cardioversion. Synchronized electrical cardioversion was occurred within 12 hours after TEE using 100-200 Joules. We also evaluated LA size and the global strain of LAA. Results Sinus rhythm restoration was succeeded in 80% of patients and maintained until discharge, 48 hours later. TDI velocities &gt; 8cm/s were correlated with successful cardioversion (sensitivity 70% and specificity 63%) and were more predictive compared to PW Doppler velocities of &gt; 40cm/s. TDI recordings at the medial LAA wall were more accurate, with less artefacts and better positioning of the sample volume. Global longitudinal strain was not significantly correlated with CV outcome. Conclusion Our results indicate that TDI velocities of the LAA walls more than 8cm/s could be used as a cut-off value predicting successful cardioversion of AF.

Left atrial appendage morphology assessment for risk stratification of embolic stroke in patients with atrial fibrillation: A meta-analysis

Heart Rhythm ◽  
2016 ◽  
Vol 13 (7) ◽  
pp. 1402-1409 ◽  
Author(s):  
Florentino Lupercio ◽  
Juan Carlos Ruiz ◽  
David F. Briceno ◽  
Jorge Romero ◽  
Pedro A. Villablanca ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Stratification ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Meta Analysis ◽  
Embolic Stroke ◽  
Atrial Appendage
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