Abstract 12793: Deterioration of Left Atrial Wall Motion Velocity May Predict Left Atrial Appendage Dysfunction in Acute Cerebral Embolism Patients with Paroxysmal Atrial Fibrillation
Background: Although the importance of left atrial dysfunction with chronic atrial fibrillation in the pathogenesis of cerebral embolism is known, its importance in patients with paroxysmal atrial fibrillation has not been clearly shown. Recently, pulse wave tissue doppler imaging (PW-TDI) has offered a new technique for assessing left atrial and appendage functions.
Methods: We performed trans-thoracic and -esophageal echocardiographies in 41 consecutive acute cerebral embolism patients without obvious left ventricular dysfunctions who were showing sinus rhythm on echocardiographic studies within seven days after onset. We classified patients into two groups: those with paroxysmal atrial fibrillation (group P, n=13, 65±10 years) and those without (group N, n=28, 60±10 years). Left atrial wall motion velocity was obtained from PW-TDI, with the sample volume placed at the anterior wall from the long axis view on trans-thoracic echocardiography.
Results: Left atrial wall motion velocities showed triphasic waves: after the P wave (Va), during systole, and during early-diastole. Although there were no significant differences in left atrial diameters (LAD), deceleration time and the ratio of the diastolic trans-mitral inflow velocities (DcT and E/A), or ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity (E/E′) between the groups, left atrial appendage emptying peak flow velocities (LAA-eV), fractional area changes (LAA-FAC), and Va were significantly decreased in Group P compared with Group N (0.49±0.22 vs. 0.78±0.22 m/sec; p<0.001, 54±31 vs. 92±14 % p<0.0001, 5.5±2.3 vs. 7.3±1.7 cm/sec; p<0.01, respectively). In addition, Va was significantly correlated with LAA-eV and LAA-FAC (Va vs. LAA-eV, r=0.576: p<0.0001; Va vs. LAA-FAC, r=0.682: p<0.0001). Furthermore, a multivariate logistic regression analysis revealed that only Va was an independent predictor of LAA dysfunction (odds ratio 3.33; 95% confidence interval 1.011–10.955; p<0.05).
Conclusions: The presence of left atrial appendage dysfunction estimated by left atrial wall motion velocity obtained from PW-TDI may predict paroxysmal atrial fibrillation in patients with acute cerebral embolism.
- © 2010 by American Heart Association, Inc.