Prevalence and Predictors of Left Atrial Appendage Inactivity in patients of Rheumatic Mitral Stenosis in Sinus Rhythm- An observational study.

BACKGROUND: Systemic thromboembolism is a known complication of rheumatic mitral stenosis (RMS) in sinus rhythm (SR). Left atrial appendage (LAA), the commonest site of thrombus formation is usually hypocontractile (inactive) in such patients. We aimed to study the prevalence of LAA inactivity (LAAI) in severe RMS and assess its independent predictors. METHODS: The study population consisted of 100 patients of severe RMS in sinus rhythm. Transthoracic and transesophageal echocardiography were done to assess LAA contractile function. Patients with LAA-peak emptying velocity <25 cm/sec were defined as having LAAI. RESULTS: The mean age of study subjects was 31.66±8.69 years and 56% were females. 73% patients had LAAI (Group A), while remaining 27% had normal LAA function (Group B). Mitral-valve area (MVA) and lateral annulus systolic velocity (Sa-wave) were significantly lower while mean pressure gradient across mitral valve (MGMV) and serum fibrinogen were significantly higher (all p-values <0.001) in group A patients. On multivariate regression analysis, MGMV (p<0.001), Sa-wave (p=0.02) and serum fibrinogen (p=0.005) were independent predictors of LAAI. Optimal cut-off values of MGMV, Sa-wave and serum fibrinogen for predicting LAAI were 11.5mmHg, 6.8cm/sec and 300mg/dL respectively.67(90.55%) patients in group A compared to 13(48.1%) in group B had LA/LAA smoke. LAAI was the only independent predictor of left atrium (LA)/LAA smoke and associated thrombus. CONCLUSION: There is high prevalence of LAAI in patients of severe MS in SR. MGMV, Sa-wave and serum fibrinogen levels are independent predictors of LAAI. LAAI is an independent predictor of LA/LAA smoke and associated thrombus.

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Role of Mitral Annular Systolic Velocity in The Evaluation of Left Atrial Appendage Function in Mitral Stenosis

Cardiovascular Journal ◽

10.3329/cardio.v1i1.8201 ◽

1970 ◽

Vol 1 (1) ◽

pp. 26-33

Author(s):

AAS Majumder ◽

MS Tanveer ◽

AQM Reza ◽

AW Chowdhury ◽

M Shahabuddin

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Mitral Stenosis ◽

Left Atrial ◽

Left Atrial Appendage ◽

Independent Predictor ◽

Atrial Appendage ◽

Tissue Imaging ◽

S Wave ◽

Group B

Background : Mitral stenosis (MS) is the most common valvular heart disease. Thromboembolism is one of the most important complications of MS, especially when it is associated with atrial fibrillation (AF).Patients with sinus rhythm (SR) are also sussceptible to this complication when it is associated with left atrial appendage (LAA) dysfunction .LAA dysfunction is an independent predictor of thromboembolism in mitral stenosis. Objectives: To investigate whether there is a relation between mitral annular velocities obtained by Doppler tissue imaging (DTI) and LAA function determined by transoesophageal echocardiography (TEE) and to determine if the annular velocities can predict the presence of the inactive LAA in MS. Methods: Sixty MS patients were evaluated by transthoracic echocardiography and all patients underwent transesophageal echocardiography. The annular systolic (S-wave) and diastolic (Emand Am-waves) velocities were recorded. Inactive LAA was defined as LAA emptying velocity <25 cm/sec. Patients were divided into three groups; group AI (n = 18): sinus rhythm (SR) and LAA emptying velocity e”25 cm/sec, group AII (n =22): SR and LAA emptying velocity <25cm/sec and group B (n = 20): atrial fibrillation. Results: Thrombus was detected in 14 patients and spontaneous echo contrast (SEC) was detected in 48 patients. Both S-wave and peak LAA emptying velocities were decreasing, while SEC frequency and density were increasing from group A to group B. There was a positive correlation between LAA emptying vs. S-wave and LAA emptying vs. Am velocities (p < 0.001, r = 0.708 and p< 0.001, r=0.495). Multivariate regression analysis showed that only S-wave is the independent predictor of inactive LAA (p = 0.001, odds ratio = 0.133, 95% CI = 0.032–0.556). In patients with SR, the cutoff value of S-wave was 14 cm/sec for the prediction of the presence of inactive LAA (sensitivity: 92.3%, specificity: 95.3%). Conclusions: S-wave is an independent predictor of inactive LAA and a useful parameter in estimating inactive LAA in MS with SR.. Key words: Mitral stenosis, Left atrial appendage function, Annular systolic velocityDOI: http://dx.doi.org/10.3329/cardio.v1i1.8201 Cardiovasc. j. 2008; 1(1) : 26-33

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