Altered left atrial appendage function associated with cardioembolic stroke in patients with rheumatic heart disease

Background: Left atrial appendage (LAA) is usually the first site for thrombus formation in rheumatic heart disease (RHD). LAA function is altered in RHD which may predispose it to thrombus formation. The aim of this study was to determine an association between function of LAA and cardioembolic stroke.Methods:Total 132 patients with RHD were studied by means of transthoracic echocardiography and/or transesophageal echocardiography and left atrial (LA) size, LAA ejection fraction (EF) and peak flow velocities were measured. These patients were followed up for 18 months with reference to development of cardioembolic stroke.Results: Seventy nine patients had atrial fibrillation (AF), of which 34 had thrombus in LAA. Out of 53 patients with sinus rhythm, 5 had LAA thrombus. Mean LAA EF was significantly lower in patients with thrombus in LAA, so was the peak flow velocity (both variables p<0.0001). Saw tooth LAA outflow velocity pattern was visible in 30 (80%) patients with LAA thrombus versus 20 (28%) patients without LAA thrombus. Total 14 patients experienced cardioembolic stroke. Patients with cardioembolic stroke had lower mean LAA EF and peak flow velocity as compared to patients without cardioembolic stroke.Conclusions:Increased LAA size, reduced LAA EF and reduced peak flow velocity are associated with increased risk of cardioembolic stroke. LAA evaluation should be mandatory in deciding treatment strategies in patients with RHD and AF.

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Light and electron microscopic features of surgically excised left atrial appendage in rheumatic heart disease patients with atrial fibrillation and sinus rhythm

Cardiovascular Pathology ◽

10.1016/j.carpath.2014.07.008 ◽

2014 ◽

Vol 23 (6) ◽

pp. 319-326 ◽

Cited By ~ 15

Author(s):

Shruti Sharma ◽

Gautam Sharma ◽

Milind Hote ◽

V Devagourou ◽

Vikas Kesari ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Disease ◽

Sinus Rhythm ◽

Rheumatic Heart Disease ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Electron Microscopic ◽

Microscopic Features ◽

Rheumatic Heart

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Role of Lymphocyte Subsets in Pathogenesis of Chronic Rheumatic Heart Disease

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239800600207 ◽

1998 ◽

Vol 6 (2) ◽

pp. 104-107

Author(s):

Rajendar K Suri ◽

Neerod K Jha ◽

Harpreet Vohra ◽

Ratna S Manjari ◽

Rajam Venkateshwaran ◽

...

Keyword(s):

Flow Cytometry ◽

T Cells ◽

Heart Disease ◽

Rheumatic Heart Disease ◽

Left Atrial ◽

Left Atrial Appendage ◽

Lymphocyte Subsets ◽

Cd4 Cells ◽

Activated T Cells ◽

Rheumatic Heart

Analyses of lymphocyte subsets using flow cytometry were conducted to determine the significance of these cells in the pathogenesis of chronic rheumatic heart disease. Lymphocytes (B cells, T cells, CD4 cells, CD8 suppressor or cytotoxic T cells, activated T cells, and natural killer cells) were measured in blood and left atrial appendage samples of 30 patients with rheumatic heart disease and 10 patients with acyanotic congenital heart disease. Monoclonal fluorescent-labeled antibodies were used to identify various cells by flow cytometry. There was a significant increase in CD4 cells and activated T cells with a significant decrease in B cells in the left atrial appendage tissue of patients with rheumatic heart disease compared to those in the control group. There was no significant difference between the two groups in the distribution pattern of T lymphocytes in peripheral blood. These changes in rheumatic heart disease reflect an abnormal immunoregulatory mechanism with an ongoing enhanced immunological process continuing into the chronic phase of the disease. In our opinion, this persistent T cell response may lead to fresh damage to the myocardium and deformation of the heart valves.

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Increased Serum Uric Acid Levels Are Correlated with Decreased Left Atrial Appendage Peak Flow Velocity in Patients with Atrial Fibrillation

Medical Principles and Practice ◽

10.1159/000373892 ◽

2015 ◽

Vol 24 (3) ◽

pp. 263-268 ◽

Cited By ~ 2

Author(s):

Murat Celik ◽

Emre Yalcinkaya ◽

Uygar Cagdas Yuksel ◽

Yalcin Gokoglan ◽

Baris Bugan ◽

...

Keyword(s):

Atrial Fibrillation ◽

Uric Acid ◽

Flow Velocity ◽

Serum Uric Acid ◽

Left Atrial ◽

Left Atrial Appendage ◽

Peak Flow ◽

Atrial Appendage ◽

Peak Flow Velocity

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The significance of the left atrial appendage in rheumatic heart disease.

Circulation ◽

10.1161/01.cir.54.1.146 ◽

1976 ◽

Vol 54 (1) ◽

pp. 146-153 ◽

Cited By ~ 3

Author(s):

M J Kelley ◽

L P Elliott ◽

S T Shulman ◽

E M Ayoub ◽

B E Victorica ◽

...

Keyword(s):

Heart Disease ◽

Rheumatic Heart Disease ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Rheumatic Heart

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Trans-esophageal Echocardiographic Assessment of Left Atrial and Left Atrial Appendage Function in Atrial Fibrillation and Rheumatic Heart Disease

Cureus ◽

10.7759/cureus.18653 ◽

2021 ◽

Author(s):

Rajat Jain ◽

Puneet Aggarwal ◽

Mukesh J Jha ◽

Bhagya Narayan Pandit ◽

Preeti Gupta ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Disease ◽

Rheumatic Heart Disease ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Echocardiographic Assessment ◽

Rheumatic Heart

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Altered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling

Scientific Reports ◽

10.1038/s41598-021-85176-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ahmet Demirkiran ◽

Raquel P. Amier ◽

Mark B. M. Hofman ◽

Rob J. van der Geest ◽

Lourens F. H. J. Robbers ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Flow Velocity ◽

Paroxysmal Atrial Fibrillation ◽

Left Atrial ◽

Peak Flow ◽

Thrombus Formation ◽

Clinical Value ◽

4D Flow ◽

Ssfp Cine

AbstractThe pathophysiology behind thrombus formation in paroxysmal atrial fibrillation (AF) patients is very complex. This can be due to left atrial (LA) flow changes, remodeling, or both. We investigated differences for cardiovascular magnetic resonance (CMR)-derived LA 4D flow and remodeling characteristics between paroxysmal AF patients and patients without cardiac disease. In this proof-of-concept study, the 4D flow data were acquired in 10 patients with paroxysmal AF (age = 61 ± 8 years) and 5 age/gender matched controls (age = 56 ± 1 years) during sinus rhythm. The following LA and LA appendage flow parameters were obtained: flow velocity (mean, peak), stasis defined as the relative volume with velocities < 10 cm/s, and kinetic energy (KE). Furthermore, LA global strain values were derived from b-SSFP cine images using dedicated CMR feature-tracking software. Even in sinus rhythm, LA mean and peak flow velocities over the entire cardiac cycle were significantly lower in paroxysmal AF patients compared to controls [(13.1 ± 2.4 cm/s vs. 16.7 ± 2.1 cm/s, p = 0.01) and (19.3 ± 4.7 cm/s vs. 26.8 ± 5.5 cm/s, p = 0.02), respectively]. Moreover, paroxysmal AF patients expressed more stasis of blood than controls both in the LA (43.2 ± 10.8% vs. 27.8 ± 7.9%, p = 0.01) and in the LA appendage (73.3 ± 5.7% vs. 52.8 ± 16.2%, p = 0.04). With respect to energetics, paroxysmal AF patients demonstrated lower mean and peak KE values (indexed to maximum LA volume) than controls. No significant differences were observed for LA volume, function, and strain parameters between the groups. Global LA flow dynamics in paroxysmal AF patients appear to be impaired including mean/peak flow velocity, stasis fraction, and KE, partly independent of LA remodeling. This pathophysiological flow pattern may be of clinical value to explain the increased incidence of thromboembolic events in paroxysmal AF patients, in the absence of actual AF or LA remodeling.

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