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Ma G, Fang L, Lin X, Gao P, Fang Q. Relationship between left ventricular diastolic function and the risk of left atrial appendage thrombus in patients with nonvalvular atrial fibrillation. Int J Cardiovasc Imaging 2023; 39:35-42. [PMID: 36598680 DOI: 10.1007/s10554-022-02690-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/01/2022] [Indexed: 02/01/2023]
Abstract
In patients with nonvalvular atrial fibrillation (NVAF), the impact of left ventricular diastolic function on the risk of left atrial appendage (LAA) thrombus has rarely been studied. This prospective study aimed to investigate the relationship between diastolic function and the risk of LAA thrombus in patients with NVAF. Seventy-six patients with NVAF admitted to receive radiofrequency catheter ablation were prospectively enrolled. All the patients underwent transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in 24 h before ablation. Diastolic function was estimated by TTE including left atrial volume index (LAVI) and E/e', as well as invasive left atrial pressure (LAP) measured during the ablation procedure. LAA peak emptying velocity (LAA-PEV) and the intensity of spontaneous echo contrast (SEC) were determined by TEE. Average E/e', LAVI and mean LAP had a significant positive correlation with the intensity of SEC, the coefficient of correlation were 0.344 (p = 0.002), 0.416 (p < 0.001) and 0.402 (p < 0.001), respectively. After adjustment for CHA2DS2-VASc score and type of AF, multivariate regression analysis revealed that increased LAP (OR 1.144, 95% CI 1.012-1.293, p = 0.031) independently correlated with the risk of LAA thrombus (SEC ≥ Grade 2). LAA-PEV showed a significantly inverse relationship with mean LAP in patients with AF (r = - 0.525, p < 0.001), and in the assessment of elevated LAP with TEE, the LAA-PEV cut-off of 0.40 m/s had a sensitivity of 80%, specificity of 81%. Left ventricular diastolic dysfunction may constitute a potential risk for LAA thrombus and stroke. Furthermore, evaluation of LAA emptying with use of TEE is helpful for assessing the LAP status of patients with AF.
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Gawałko M, Budnik M, Uziębło-Życzkowska B, Krzesiński P, Scisło P, Kochanowski J, Jurek A, Kiliszek M, Gielerak G, Filipiak KJ, Opolski G, Kapłon-Cieślicka A. Decreased left atrial appendage emptying velocity as a link between atrial fibrillation type, heart failure and older age and the risk of left atrial thrombus in atrial fibrillation. Int J Clin Pract 2020; 74:e13609. [PMID: 32654352 DOI: 10.1111/ijcp.13609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Decreased left atrial appendage emptying velocity (LAAV) is a known predictor of LAA thrombus in atrial fibrillation (AF). The aim of our study was to identify which of the clinical risk factors for LAA thrombus are associated with decreased LAAV. METHODS The study included 1476 consecutive AF patients who underwent transesophageal echocardiography (TEE) before AF direct current cardioversion or ablation in two high-reference cardiology departments. Patients were divided into two groups: 71 (4.8%) patients with LAAV < 20 cm/s and 1405 patients (95%) with LAAV ≥ 20 cm/s. RESULTS Compared with patients with LAAV ≥ 20 cm/s, those with decreased LAAV were older, more often had non-paroxysmal AF, were burdened with more concomitant diseases (including hypertension, diabetes, vascular disease, and heart failure [HF]) with higher median CHA2 DS2 -VASc score (3 [2-4] vs 2 [1-3], P < .0001), and had lower glomerular filtration rate (GFR). Prevalence of LAA thrombus was higher in patients with decreased LAAV compared with those with LAAV ≥ 20cm/s (20% vs 4.6%, P < .0001). In patients with decreased LAAV, there was no difference in the frequency of LAA thrombus between those treated with VKA and those receiving NOAC, while in patients with LAAV ≥ 20 cm/s a trend was observed towards a benefit with NOAC. In multivariate logistic regression, non-paroxysmal AF, HF and age ≥ 65 years predicted both LAAV < 20 cm/s and LAA thrombus, while GFR < 60 mL/min/1.73 m2 predicted only the presence of LAA thrombus. CONCLUSION One in five AF patients with decreased LAAV had LAA thrombus, regardless of the type of OAC. Non-paroxysmal AF, HF and age ≥ 65 years might increase LAA thrombus risk via reduced LAAV.
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Affiliation(s)
- Monika Gawałko
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Monika Budnik
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Piotr Scisło
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Kochanowski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Jurek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Marek Kiliszek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Grzegorz Gielerak
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | | | - Grzegorz Opolski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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Hwang SH, Roh SY, Shim J, Choi JI, Kim YH, Oh YW. Atrial Fibrillation: Relationship between Left Atrial Pressure and Left Atrial Appendage Emptying Determined with Velocity-encoded Cardiac MR Imaging. Radiology 2017; 284:381-389. [DOI: 10.1148/radiol.2017161654] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sung Ho Hwang
- From the Department of Radiology (S.H.H., Y.W.O.) and Division of Cardiology, Department of Internal Medicine (S.Y.R., J.S., J.I.C., Y.H.K.), Korea University Anam Hospital, Anam-dong 5-ga, Seongbuk-gu, Seoul 136-705, Republic of Korea
| | - Seung Young Roh
- From the Department of Radiology (S.H.H., Y.W.O.) and Division of Cardiology, Department of Internal Medicine (S.Y.R., J.S., J.I.C., Y.H.K.), Korea University Anam Hospital, Anam-dong 5-ga, Seongbuk-gu, Seoul 136-705, Republic of Korea
| | - Jaemin Shim
- From the Department of Radiology (S.H.H., Y.W.O.) and Division of Cardiology, Department of Internal Medicine (S.Y.R., J.S., J.I.C., Y.H.K.), Korea University Anam Hospital, Anam-dong 5-ga, Seongbuk-gu, Seoul 136-705, Republic of Korea
| | - Jong-il Choi
- From the Department of Radiology (S.H.H., Y.W.O.) and Division of Cardiology, Department of Internal Medicine (S.Y.R., J.S., J.I.C., Y.H.K.), Korea University Anam Hospital, Anam-dong 5-ga, Seongbuk-gu, Seoul 136-705, Republic of Korea
| | - Young-Hoon Kim
- From the Department of Radiology (S.H.H., Y.W.O.) and Division of Cardiology, Department of Internal Medicine (S.Y.R., J.S., J.I.C., Y.H.K.), Korea University Anam Hospital, Anam-dong 5-ga, Seongbuk-gu, Seoul 136-705, Republic of Korea
| | - Yu-Whan Oh
- From the Department of Radiology (S.H.H., Y.W.O.) and Division of Cardiology, Department of Internal Medicine (S.Y.R., J.S., J.I.C., Y.H.K.), Korea University Anam Hospital, Anam-dong 5-ga, Seongbuk-gu, Seoul 136-705, Republic of Korea
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Tsai WC, Liu YW, Huang YY, Tsai LM, Lin LJ. Decreased Mechanical Function of Left Atrium Assessed by Speckle Tracking and Tissue Doppler Echocardiography in Patients with Congestive Heart Failure. J Med Ultrasound 2012. [DOI: 10.1016/j.jmu.2012.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Kumak F, Gungor H. Comparison of the Left Atrial Appendage Flow Velocities between Patients with Dipper versus Nondipper Hypertension. Echocardiography 2012; 29:391-6. [DOI: 10.1111/j.1540-8175.2011.01638.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Fuller GA, Bicer S, Hamlin RL, Yamaguchi M, Reiser PJ. Increased myosin heavy chain-beta with atrial expression of ventricular light chain-2 in canine cardiomyopathy. J Card Fail 2007; 13:680-6. [PMID: 17923362 DOI: 10.1016/j.cardfail.2007.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Revised: 05/02/2007] [Accepted: 05/24/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Dilated cardiomyopathy is a naturally occurring disease in humans and dogs. Human studies have shown increased levels of myosin heavy chain (MHC)-beta in failing ventricles and the left atria (LA) and of ventricular light chain (VLC)-2 in the right atria in dilated cardiomyopathy. METHODS AND RESULTS This study evaluates the levels of MHC-beta in all heart chambers in prolonged canine right ventricular pacing. In addition, we determined whether levels of VLC2 were altered in these hearts. Failing hearts demonstrated significantly increased levels of MHC-beta in the right atria, right atrial appendage, LA, left atrial appendage (LAA), and right ventricle compared with controls. Significant levels of VLC2 were detected in the right atria of paced hearts. Differences in MHC-beta expression were observed between the LA and the LAA of paced and control dogs. MHC-beta expression was significantly greater in the LA of paced and control dogs compared with their respective LAA. CONCLUSIONS The cardiac myosin isoform shifts in this study were similar to those observed in end-stage human heart failure and more severe than those reported in less prolonged pacing models, supporting the use of this model for further study of end-stage human heart failure. The observation of consistent differences between sampling sites, especially LA versus LAA, indicates the need for rigorous sampling consistency in future studies.
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Affiliation(s)
- Geraldine A Fuller
- Department of Veterinary Biosciences, College of Veterinary Medicine, Ohio State University, Columbus, Ohio, USA
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Sevimli S, Yilmaz M, Gundogdu F, Arslan S, Gurlertop Y, Erol MK, Bozkurt E, Acikel M, Senocak H. Carvedilol Therapy Is Associated with an Improvement in Left Atrial Appendage Function in Patients with Congestive Heart Failure. Echocardiography 2007; 24:623-8. [PMID: 17584202 DOI: 10.1111/j.1540-8175.2007.00440.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Heart failure is one of the leading death reasons in the world. Left atrial appendage (LAA) is of great importance in maintaining cardiac function. We examined the effect of carvedilol therapy on left atrial appendage functions in patients with symptomatic congestive heart failure. Twenty patients with symptomatic congestive heart failure and resting ejection fraction < or = 40% were included in this study. LAA was visualized by transesophageal echocardiography. LAA area change (LAAAC), LAA empty velocity (LAAEV) and LAA empty velocity time integral (LAAEVTI) were calculated as the average of five cardiac cycles. A minimum dose of carvedilol administered to each patient, was titrated up to maximal dose that the patients could tolerate, during an 8-week period. After the third month of completing treatment, a second transthoracic and transesophageal echocardiographic study was performed. Heart rate (P < 0.001), systolic (P = 0.002) blood pressures were reduced by carvedilol therapy at the end of the third month. LAAEV (P < 0.001), LAAEVTI (P < 0.001), and LAAAC (P < 0.001) were significantly increased at the end of the third month of carvedilol therapy. This study indicates that in patients with symptomatic congestive heart failure, carvedilol therapy is associated with an improvement in left atrial appendage function.
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Affiliation(s)
- Serdar Sevimli
- Department of Cardiology, Medical School Hospital, Ataturk University, Erzurum, Turkey.
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Vural A, Agacdiken A, Ural D, Sahin T, Kozdag G, Kahraman G, Ural E, Akbas H, Suzer K, Komsuoglu B. Effect of cardiac resynchronization therapy on left atrial appendage function and pulmonary venous flow pattern. Int J Cardiol 2005; 102:103-9. [PMID: 15939105 DOI: 10.1016/j.ijcard.2004.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2003] [Revised: 05/02/2004] [Accepted: 05/05/2004] [Indexed: 11/19/2022]
Abstract
BACKGROUND Previous studies have shown improvement in left ventricular function and development of the reverse remodeling in the left ventricle and left atrium after cardiac resynchronization therapy (CRT). The aim of this study was to investigate the effect of CRT on left atrial appendage (LAA) function and pulmonary venous flow pattern. METHODS Eighteen patients with systolic heart failure and complete left bundle branch block underwent implantation of biventricular pacemaker devices. In order to follow changes in LAA, transthoracic and transesophageal echocardiographic examinations were performed 1 week before and repeated 1 and 6 months after pacemaker implantation. RESULTS CRT resulted in significant clinical improvement and decrease in NYHA functional class in 17 patients (94%). Maximum and minimum areas of left atrial appendage (LAAAmax and LAAAmin) decreased, with a concomitant increase in LAA ejection fraction. [LAAAmax: from 4.6+/-2 to 4.2+/-1.8 cm2 at the first (P < 0.001) and to 4.0+/-1.8 cm2 at the sixth month (P < 0.001); LAAAmin: from 2.7+/-1.3 to 2.3+/-1.2 cm2 at the first (P < 0.001) and to 2.2+/-1.2 cm2 at the sixth month (P < 0.001) and LAA ejection fraction: from 41+/-12% to 46+/-10% at the first (P = 0.007) and to 47+/-8% at the sixth month (P = 0.003)]. LAA active emptying and filling flow and pulmonary venous systolic velocities also increased after CRT. The appendage active emptying velocity correlated significantly with left ventricular ejection fraction (r = 0.50, P = 0.002), LAA ejection fraction (r = 0.51, P = 0.002), left atrial maximal volume, LAVmax (r = -0.44, P = 0.007), left atrial minimal volume, LAVmin (r = -0.50, P = 0.002) and pulmonary vein systolic flow velocity (r = 0.33, P = 0.05). CONCLUSION Treatment of heart failure by CRT results with marked improvements in LAA function and increases pulmonary venous systolic velocity.
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Affiliation(s)
- Ahmet Vural
- Department of Cardiology, Kocaeli University Medical Faculty, 41900 Derince, Kocaeli, Turkey.
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