The value of diastolic function parameters in the prediction of left atrial appendage thrombus in patients with nonvalvular atrial fibrillation

Cardiovascular Ultrasound

Research

Rasa Kazlauskaite¹  Vijaiganesh Nagarajan²  Marek Cena²  Enrique Garcia-Sayan³  Anna Demopoulos⁴  Noreen T Nazir⁴  George J Karam⁴  Richard G Trohman⁴  Heather Gage⁴  Rami Doukky⁵ 

[1] Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA;Division of Adult Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA;Division of Cardiology, Mount Sinai Hospital, Chicago, Il, USA;Division of Cardiology, Rush University Medical Center, 1653 W. Congress Pkwy, 60612, Chicago, IL, USA;Division of Cardiology, Rush University Medical Center, 1653 W. Congress Pkwy, 60612, Chicago, IL, USA;Division of Adult Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA;

关键词: Diastolic function;    Left atrial appendage thrombus;    Spontaneous echo contrast (SEC);    Atrial fibrillation;   

DOI  :  10.1186/1476-7120-12-10

 received in 2014-01-13, accepted in 2014-02-17,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundLeft ventricular diastolic impairment and consequently elevated filling pressure may contribute to stasis leading to left atrial appendage thrombus (LAAT) in nonvalvular atrial fibrillation (AF). We investigated whether transthoracic echocardiographic parameters can predict LAAT independent of traditional clinical predictors.MethodsWe conducted a retrospective cohort study of 297 consecutive nonvalvular AF patients who underwent transthoracic echocardiogram followed by a transesophageal echocardiogram within one year. Multivariate logistic regression analysis models were used to determine factors independently associated with LAAT.ResultsNineteen subjects (6.4%) were demonstrated to have LAAT by transesophageal echocardiography. These patients had higher mean CHADS2 scores [2.6 ± 1.2 vs. 1.9 ± 1.3, P = 0.009], higher E:e’ ratios [16.6 ± 6.1 vs. 12.0 ± 5.4, P = 0.001], and lower mean e’ velocities [6.5 ± 2.1 cm/sec vs. 9.1 ± 3.2 cm/sec, P = 0.001]. Both E:e’ and e’ velocity were associated with LAAT formation independent of the CHADS2 score, warfarin therapy, left ventricular ejection fraction (LVEF), and left atrial volume index (LAVI) [E:e’ odds-ratio = 1.14 (95% confidence interval = 1.03 – 1.3), P = 0.009; e’ velocity odds-ratio = 0.68 (95% confidence interval = 0.5 – 0.9), P = 0.007]. Similarly, diastolic function parameters were independently associated with spontaneous echo contrast.ConclusionThe diastolic function indices E:e’ and e’ velocity are independently associated with LAAT in nonvalvular AF patients and may help identify patients at risk for LAAT.

【 授权许可】

CC BY   
© Doukky et al.; licensee BioMed Central Ltd. 2014