Abstract 2170: Increased Ratio Of The Diastolic Mitral Annular Velocities Is Associated With Left Atrial Appendage Thrombus Formation In Acute Ischemic Stroke Patients With Sinus Rhythm
Introduction: The early diastolic mitral annular velocity obtained by Doppler tissue imaging (E′) is a preload independent index of left ventricular relaxation.
Hypothesis: The ratio of the diastolic mitral annular velocities (E′/A′) is a useful predictor for left atrial dysfunction and thrombus formation in patients with acute ischemic stroke.
Methods: One hundred and one acute ischemic stroke patients were enrolled if they met all of the following criteria; ≥50 years of age, normal sinus rhythm on admission, and underwent TEE within 7 days from the onset. We examined E′, A′, and the ratio of the early diastolic transmitral inflow velocity to E′ (E/E′) on admission, and compared with the TEE findings in diagnosing intra-cardiac thrombus formation.
Results: There were 30 cases with E′/A′ ≥1.0 (1.33±0.25, age 70±12 years old) and 71 with <1.0 (0.63±0.12, 73±10 yo) in the study subjects. There were no significant differences in age, left atrial and ventricular end-diastolic dimension, percent fractional shortening, plasma levels of brain natriuretic peptide, and E/E′ ratio between the two groups (E/E′, 8.4±1.3 vs. 7.7±2.4, NS). Cases with E′/A′ ≥1.0 had higher incidence of left atrial appendage (LAA) thrombus formation and/or spontaneous echograhic contrast (SEC), and smaller A′ than those with <1.0 (thrombus and/or SEC, 33% vs. 6%, P<0.001; A′, 7.5±2.3 vs. 12.0±3.4 cm/s, P=0.0058). There was a significant linear relationship between E′/A′ and emptying flow velocity of the LAA (R= −0.542, P<0.001). On multivariate logistic regression analysis, E′/A′ was an independent predictor for LAA thrombus (RR 1.532 per +1SD increase, 95% confidence interval 1.130 to 2.081, P<0.001).
Conclusion: It may be possible to predict LAA dysfunction and thrombus formation using evaluation of the E′/A′ in trans-thoracic echocardiographic study on admission in patients with ischemic stroke.