The relationship between atrial electromechanical delay and left atrial mechanical function in stroke patients

Abstract Introduction Around 25% of all ischaemic strokes have no known cause despite standard investigations. Most of these cases are suspected to have an embolic source for ischaemia, leading to the moniker of Embolic Stroke of Undetermined Source (ESUS). Recent studies suggest that abnormalities of the left atrium, in the form of atrial cardiopathy, can lead to increased risk of stroke even in the absence of atrial fibrillation (AF), which may be either as precursors to AF or as independent risk factors for the development of left atrial thrombus and subsequent stroke. Purpose The aim of this study was to measure LA electromechanical dissociation, LA volumes and P-wave dispersion as markers of atrial cardiopathy in patients with ESUS to determine whether atrial cardiopathy may be in the causal pathway of ESUS. Methods 28 patients presenting with ischaemic stroke and fulfilling the criteria for ESUS were enrolled into this cross-sectional, observational study. All patients had 24-hour Holter monitoring done to rule out the presence of AF. The control group consisted of 28 age- and gender-matched apparently healthy individuals. On ECG, P-wave Dispersion (PWD) was calculated by subtracting minimum P-wave duration from maximum P-wave duration. On echocardiography, time intervals from the beginning of P-wave to beginning of A' wave from the lateral mitral annulus in tissue doppler imaging was measured as the atrial electromechanical delay. LA volumes were recorded using the Modified Biplane Simpson's method. Statistical analysis was performed using student's t-test, chi-square test, and Pearson's test. Results Baseline demographic and laboratory characteristics were similar between the two groups. Increased PWD (34.14±9.89 ms vs. 27.32±8.95 ms; p=0.01), atrial electromechanical delay (73.32±16.31 ms vs. 63.63±13.59 ms; p=0.02) and LA volumes were observed in patients with ESUS as compared to controls. A significant correlation was also found between these parameters (p<0.01). Discussion According to the results of our study, PWD, atrial electromechanical delay and LA volumes may be novel predictors for ESUS. Atrial cardiopathy is a unique mechanism of thrombo-embolism in ESUS patients and our data establishes its association with ESUS. Further studies will be needed to shed more light on its role in the causality of stroke in the ESUS population. Measurement of electromechanical delay Funding Acknowledgement Type of funding source: None

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Percutaneous left atrial appendage closure improves left atrial mechanical function through Frank–Starling mechanism

Heart Rhythm ◽

10.1016/j.hrthm.2017.01.042 ◽

2017 ◽

Vol 14 (5) ◽

pp. 710-716 ◽

Cited By ~ 6

Author(s):

Augustin Coisne ◽

Rosario Pilato ◽

François Brigadeau ◽

Didier Klug ◽

Christelle Marquie ◽

...

Keyword(s):

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage ◽

Mechanical Function ◽

Left Atrial Appendage Closure ◽

Atrial Mechanical Function

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Left Atrial Mechanical Function and Global Strain in Hypertrophic Cardiomyopathy

PLoS ONE ◽

10.1371/journal.pone.0157433 ◽

2016 ◽

Vol 11 (6) ◽

pp. e0157433 ◽

Cited By ~ 8

Author(s):

Kyung-Jin Kim ◽

Hong-Mi Choi ◽

Yeonyee E. Yoon ◽

Hack-Lyoung Kim ◽

Seung-Pyo Lee ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Left Atrial ◽

Mechanical Function ◽

Global Strain ◽

Atrial Mechanical Function

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Left atrial mechanical function after cardioversion of atrial fibrillation estimation by pulmonary venous and transmitral flow velocity patterns

Pathophysiology ◽

10.1016/0928-4680(94)90422-7 ◽

1994 ◽

Vol 1 ◽

pp. 202

Author(s):

A. Iuchi ◽

T. Oki ◽

N. Fukuda ◽

T. Tabata ◽

Y. Kageji ◽

...

Keyword(s):

Atrial Fibrillation ◽

Flow Velocity ◽

Left Atrial ◽

Mechanical Function ◽

Transmitral Flow ◽

Atrial Mechanical Function

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Left atrial appendage orifice area and morphology is closely associated with flow velocity in patients with nonvalvular atrial fibrillation

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02242-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lei Chen ◽

Changjiang Xu ◽

Wensu Chen ◽

Chaoqun Zhang

Keyword(s):

Atrial Fibrillation ◽

Flow Velocity ◽

Left Atrial ◽

Left Atrial Appendage ◽

Linear Regression Analysis ◽

Left Ventricular ◽

Atrial Appendage ◽

Mechanical Function ◽

Orifice Area ◽

The Relationship

Abstract Background Thromboembolic events are the most serious complication of atrial fibrillation (AF), and the left atrial appendage (LAA) is the most important site of thrombosis in patients with AF. During the period of COVID-19, a non-invasive left atrial appendage detection method is particularly important in order to reduce the exposure of the virus. This study used CT three-dimensional reconstruction methods to explore the relationship between LAA morphology, LAA orifice area and its mechanical function in patients with non-valvular atrial fibrillation (NVAF). Methods A total of 81 consecutive patients with NVAF (36 cases of paroxysmal atrial fibrillation and 45 cases of persistent atrial fibrillation) who were planned to undergo catheter radiofrequency ablation were enrolled. All patients were examined by transthoracic echocardiography (TTE), TEE, and computed tomography angiography (CTA) before surgery. The LAA orifice area was obtained according to the images of CTA. According to the left atrial appendage morphology, it was divided into chicken wing type and non-chicken wing type. At the same time, TEE was performed to determine left atrial appendage flow velocity (LAAFV), and the relationship between the left atrial appendage orifice area and LAAFV was analyzed. Results The LAAFV in Non-chicken wing group was lower than that in Chicken wing group (36.2 ± 15.0 cm/s vs. 49.1 ± 22.0 cm/s, p-value < 0.05). In the subgroup analysis, the LAAFV in Non-chicken wing group was lower than that in Chicken wing group in the paroxysmal AF (44.0 ± 14.3 cm/s vs. 60.2 ± 22.8 cm/s, p-value < 0.05). In the persistent AF, similar results were observed (29.7 ± 12.4 cm/s vs. 40.8 ± 17.7 cm/s, p-value < 0.05). The LAAFV in persistent AF group was lower than that in paroxysmal AF group (34.6 ± 15.8 cm/s vs. 49.9 ± 20.0 cm/s, p-value < 0.001). The LAAFV was negatively correlated with left atrial dimension (R = − 0.451, p-value < 0.001), LAA orifice area (R= − 0.438, p-value < 0.001) and left ventricular mass index (LVMI) (R= − 0.624, p-value < 0.001), while it was positively correlated with LVEF (R = 0.271, p-value = 0.014). Multiple linear regression analysis showed that LAA morphology (β = − 0.335, p-value < 0.001), LAA orifice area (β = − 0.185, p-value = 0.033), AF type (β = − 0.167, p-value = 0.043) and LVMI (β = − 0.465, p-value < 0.001) were independent factors of LAAFV. Conclusions The LAA orifice area is closely related to the mechanical function of the LAA in patients with NVAF. The larger LAA orifice area and LVMI, Non-chicken wing LAA and persistent AF are independent predictors of decreased mechanical function of LAA, and these parameters might be helpful for better management of LA thrombosis.

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