scholarly journals STUDY OF PREVALENCE AND FACTORS INFLUENCING THE OCCURRENCE OF LEFT ATRIAL/ LEFT ATRIAL APPENDAGE CLOT IN PATIENTS WITH RHEUMATIC HEART DISEASE & MITRAL STENOSIS IN SINUS RHYTHM VS ATRIAL FIBRILLATION.

2020 ◽  
pp. 1-4
Author(s):  
Ashish Chauhan ◽  
Rajeev Kumar Gupta ◽  
V.V. Agarwal
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Mitral Stenosis ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Normal Sinus Rhythm ◽  
Atrial Appendage ◽  
Clot Formation ◽  
Spontaneous Echo Contrast ◽  
Significant Difference

BACKGROUND: The purpose of this study was to prospectively evaluate a large group of consecutive, non-anticoagulated patients with RHD (rheumatic mitral stenosis) and to analyze the left atrial appendage function in relation to left atrial appendage clot and spontaneous echo contrast formation in patients who were in SR vs. in AF. METHODS AND RESULTS: This is a hospital based observational study conducted in department of cardiology, S. M. S. MEDICAL COLLEGE and associated hospital, Jaipur, Rajasthan; between march 2016 to august 2017. We prospectively studied clinical and echocardiographic parameters of LA/LAA in 303 consecutive patients with mitral stenosis who underwent trans-esophageal echocardiography and correlated it with spontaneous echo contrast and left atrial appendage clot. The mean age of the patients was 32.94 years. One hundred thirty seven (45.21%) patients were in atrial fibrillation and 166 (54.79%) patients were in sinu rhythm. We found a statistically significant difference in the age of presentation (29.16/33.93/36.68 Yr; P =0.006/<0.001), MVA (1.17/0.8/0.69 cm2; P=<0.001/0.024), LA diameter (39/47.24/50 cm; P=<0.001/<0.001), LAA emptying velocity (45/26.43/15 cm/sec; P=<0.001/<0.001) and EF (37.49/30.67/23.7%; P=<0.001/0.001) among the patients without spontaneous echo contrast /clot vs. with spontaneous echo contrast vs. with spontaneous echo contrast & clot. By using student t-test, we found that there was a statistically significant difference in age of presentation, BMI, MDG, LA diameter, LAA emptying velocity and EF in patients who were in sinus rhythm vs. atrial fibrillation (P<0.05). Incidence of spontaneous echo contrast was 68.67% vs. 91.97% in patients in sinus rhythm vs atrial fibrillation, while that of SEC & CLOT both was 4.22% vs. 33.58% in patients in SR vs AF. In a subgroup of the patients with LA/LAA clot, the LA diameter (55.14 : 49.98 CM; P=0.057) and the LAA emptying velocity ( 15.14 : 15.26 CM/Sec; P=0.923) were not significantly different among patients in SR vs in AF. CONCLUSION: In the patients with severe mitral stenosis, besides atrial fibrillation, a subgroup of patients in normal sinus rhythm with depressed left atrial appendage function had a higher risk of clot formation in left atrial appendage and these patients should be routinely anticoagulated for prevention of clot formation.

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

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

scholarly journals Trans-oesophageal Echocardiographic Appraisal of Left Atrial Appendage Clot in Severe Mitral Stenosis.

2014 ◽  
Vol 10 (1) ◽  
pp. 27-29
Author(s):  
Rabindra Simkhada ◽  
Man Bahadur KC ◽  
Yadav Deo Bhatt ◽  
Arun Maskey ◽  
Rabi Malla ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Mitral Stenosis ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Transoesophageal Echocardiography ◽  
Atrial Appendage ◽  
Clot Formation ◽  
Left Atrial Size ◽  
Atrial Size ◽  
Percutaneous Transvenous Mitral Commissurotomy

Background and Aims Left atrial appendage clot is a common complication of mitral stenosis. The management of patient differs significantly if there is presence of clot. Various factors had been studied as a risk factor for clot formation. We aim to assess the prevalence of left atrial appendage clot by trans-oesophageal echocardiography in patients of severe mitral stenosis planned for percutaneous transvenous mitral commissurotomy and analyze the factors responsible for it. Methods: An oservational prevalence study was conducted among 100 patients of severe mitral stenosis who were undergoing transoesophageal echocardiography before percutaneous transvenous mitral commissurotomy and prevalence of left atrial appendage clot were recorded. Data were entered in the SPSS and factors responsible for clot formation were analyzed. Results: Out of 100 enrolled patients, 69 (69%) were female. Mean age of presentation was 37.4±13.70 years. Mean age of female was 38.11±13.13 years and male was 35.80±14.98 years. Mean mitral valve area was 0.87±0.12 cm2 and mean left atrial size was 4.79±0.60 cm. Atrial Fibrillation was present in 32 (32%) patients. Transoesophageal echocardiography revealed left atrial appendage clot in 28 (28%). Gender showed no correlation with presence of clot (p=0.06). Increasing age (p=0.002), presence of Atrial Fibrillation (p=0.005) and larger left atrial size (p<0.01) showed significant positive correlation with left atrial appendage clot formation. Conclusion: Left atrial appendage clot was common finding in severe mitral stenosis patients. Patients with advanced age, presence of atrial fibrillation and larger left atrial size were more likely to have clot formation. Nepalese Heart Journal | Volume 10 | No.1 | November 2013| Pages 27-29 DOI: http://dx.doi.org/10.3126/njh.v10i1.9744

P3731The improvement in left atrial strain among patients undergoing percutaneous left atrial appendage closure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Ijuin ◽  
A Hamadanchi ◽  
F Haertel ◽  
L Baez ◽  
C Schulze ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Transesophageal Echocardiography ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Lateral Wall ◽  
Bleeding Risk ◽  
Atrial Appendage ◽  
Left Atrial Appendage Closure ◽  
Left Atrial Strain

Abstract Background Percutaneous left atrial appendage closure (LAAC) is being established as an alternative option for atrial fibrillation (AF) patients with high bleeding risk. Few studies reported the influence of percutaneous LAAC on left atrial (LA) performance, but most of the studies demonstrated no remarkable changes in their parameters after the procedure. Method The study included 95 patients (age: 75±6.7 years, 67% male) whom underwent percutaneous LAAC in a single center between September 2012 and November 2018. LA strain was evaluated at three different time intervals by transesophageal echocardiography (baseline, 45 days and 180 days after procedure). All data were analyzed using a dedicated. 70 patients had atrial fibrillation whereas 25 were in sinus rhythm. Analysis was performed for peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS) from segment of lateral wall in mid-esophageal 4 chamber view. The validity of lateral wall left atrial analysis was recently shown by our group. PACS was obtained in patients with sinus rhythm during exams. Results Compared to baseline, PALS was significantly increased after 45 days (12.4±8.4% vs 16.0±10.7%, p=0.001) and remained stable after 180 days (13.8±9.0% vs 17.0±12.4%, p=0.098). Even in only patients with atrial fibrillation during exams, it was increased (10.8±7.7% vs 13.4±7.1%, p=0.012 and 8.5±5.1% vs 13.9±8.1%, p=0.014). Similarly, compared with the baseline, PACS was significantly increased after 45 days and 180 days (5.8±3.9% vs 10.6±7.6%, p=0.001 and 4.5±2.6% vs 7.9±3.1%, p=0.036). The Changes in PALS and PACS Conclusion Our study has demonstrated for the first time the improvement in LA strain following LAAC within 45 days of implantation by transesophageal echocardiography and these values were maintained at least for 6 months. Further appraisal is warranted for confirmation of these preliminary findings.

Abstract 14676: Landmark-based Functional Computed Tomography Reveals Diminished Left Atrial Appendage Contraction During Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jonathan H Chung ◽  
Gordon Ho ◽  
Andrew Schluchter ◽  
Francisco Contijoch ◽  
Jonathan C Hsu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Ct Scan ◽  
Blood Volume ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
History Of

Introduction: The formation of thrombus in the left atrial appendage (LAA) and risk for systemic embolization may result in part from stasis and poor blood volume emptying during atrial fibrillation (AF). Functional 4-dimensional computed tomography (4DCT) is a promising technique to measure LAA ejection fraction and blood volume emptying. Hypothesis: We hypothesize that the LAA ejection fraction measured by 4DCT is decreased during AF compared to sinus rhythm. Methods: 256-slice 4DCT scans obtained in patients for coronary artery imaging or pre-procedurally for AF, VT or SVT ablation procedures were analyzed retrospectively. In each patient, LAA volumes were measured at multiple phases during one cardiac cycle using segmentation software (ITK-SNAP and Osirix MD). LAA ejection fraction was calculated as the difference between minimum and maximum volumes and was analyzed using Wilcoxon rank sum. Results: Out of 54 patients, 37 patients were in sinus rhythm and 17 patients were in AF. Between NSR vs. AF, mean age was 69.1±12.8 vs 73.2±11.5 years (p=0.13), 28% vs 36% female (p=0.54), LVEF was 58±11% vs 60±9% (p=0.95), and echo-derived left atrial volume index was 29.5±6.1 ml/m2 vs 41.7±12.8 ml/m2 (p=0.06). Patients who were in sinus rhythm during their CT scan had a higher LAA ejection fraction than those who were in AF (58±13% vs. 29±9%, p<0.0001). For patients who were in AF during their CT scan, there was no difference in LAA ejection fraction between patients with a history of paroxysmal AF compared to patients with a history of persistent AF (30±10% vs. 28±10%, p=0.75). Conclusions: Analysis of the LAA volumes using functional cardiac CT is a feasible method to quantify blood volume emptying from the LAA. Patients in AF were observed to have significantly decreased LAA ejection fraction and blood volume emptying compared to patients in sinus rhythm. Further studies are needed to determine whether this technique may improve personalized risk stratification for stroke.

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