Abstract 3904: Left Atrial Appendage Functions in Patients With Hypertrophic Cardiomyopathy and Sinus Rhythm: Transesophageal Echocardiography and Tissue Doppler Study
Bacground: Stroke and systemic embolism still remains high in patients(pts) with hypertrophic cardiomyopathy (HCM). Such events are more common in patients with atrial fibrillation (AF). However, impaired left atrial appendage (LAA) functions might lead to thrombo-embolism even in pts with sinus rhythm (SR). The aim of this cross-sectional study was a comprehensive evaluation of LAA contractile function in pts with HCM in SR.
Method: LAA functions were assessed in 62 pts with HCM in SR and compared with age and sex matched controls (n=53). Pts with history of AF and documented paroxysmal AF episodes in 24-hr Holter monitoring and depressed left ventricular (LV) ejection fraction (< 50%) were excluded. Transthoracic echocardiography was performed to determine LV functions. Transesophageal echocardiography was applied for determination of LAA blood flow Doppler velocities, LAA tissue Doppler imaging (TDI) velocities, LAA area and volume, and presence of thrombus.
Results: LAA emptying and filling velocities were significantly depressed in HCM pts (Table 1⇓). LAA thrombus was present in 5 pts (8%) with HCM in SR. LAA emptying and filling velocities were negatively correlated with age in controls (r: −0.4; p=0.005) however these velocities were not associated with age in HCM-group. Moreover, LAA emptying and filling velocities were not associated with LV mass index, LV outflow tract gradient and degree of diastolic dysfunction in HCM-group. All TDI velocities obtained from LAA walls were significantly depressed in HCM-group. Lateral LAA wall TDI velocities were moderately correlated with LV mass index in the HCM-group (r=−0.4, p:0.006).
Conclusion: LAA thrombus formation was relatively common in our patient population (8%). The significantly depressed LAA filling and emptying velocities in sinus rhythm may prone HCM pts to thrombo-embolic events. The depressed LAA-TDI parameters in HCM may indicate the presence of a possible intrinsic atrial myopathy